Department of Neurology and Headache Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany.
Nat Rev Neurol. 2016 Oct;12(10):575-83. doi: 10.1038/nrneurol.2016.124. Epub 2016 Sep 12.
Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder that occurs on ≥15 days per month for >3 months, and is caused by overuse of medication intended for acute or symptomatic headache treatment. The prevalence of MOH in the general population is around 1%, but the condition is much more common in people with headache, in particular chronic migraine. The phenotype of the headache in MOH depends on the initial primary headache and the type of overused acute medication. In this Review, we will discuss the epidemiology, risk factors, pathophysiology, prevention and treatment of MOH. Treatment of MOH is performed in three steps: educating patients about the relationship between frequent intake of acute headache medication and MOH with the aim to reduce intake of acute medication; initiation of migraine prevention (such as topiramate or onabotulinumtoxin A in migraine) in patients who fail step 1; detoxification on an outpatient basis or in a day hospital or inpatient setting, depending on severity and comorbidities. The success rate of treatment is around 50-70%, although patients whose MOH is associated with opioid overuse have higher relapse rates. In all patients with MOH, relapse rates can be reduced by patient education and care in the follow-up period.
药物过度使用性头痛（MOH）根据国际头痛疾病分类定义为原发性头痛疾病患者每月出现≥15 天、≥3 个月的头痛，且由用于急性或对症头痛治疗的药物过度使用引起。MOH 在普通人群中的患病率约为 1%，但在头痛患者中更为常见，特别是慢性偏头痛患者。MOH 头痛的表型取决于初始原发性头痛和过度使用的急性药物类型。在这篇综述中，我们将讨论 MOH 的流行病学、危险因素、病理生理学、预防和治疗。MOH 的治疗分三个步骤进行：教育患者了解频繁摄入急性头痛药物与 MOH 之间的关系，以减少急性药物的摄入；对第 1 步治疗失败的患者开始偏头痛预防（如偏头痛患者使用托吡酯或肉毒杆菌毒素 A）；根据严重程度和合并症，在门诊、日间医院或住院环境中进行解毒。治疗成功率约为 50-70%，尽管与阿片类药物过度使用相关的 MOH 患者复发率更高。在所有 MOH 患者中，通过患者教育和随访期间的护理，可以降低复发率。
