Michultka D M, Blanchard E B, Appelbaum K A, Jaccard J, Dentinger M P
Behav Res Ther. 1989;27(4):411-20. doi: 10.1016/0005-7967(89)90012-0.
'Analgesic rebound headache' is identified by habituation of an individual to pain reducing medication, the exacerbation of headache pain a few hours after medication consumption and a marked increase in headache frequency and intensity for several weeks after medication is discontinued. We describe three studies undertaken to clarify the existence and characteristics of this proposed headache syndrome. In Study 1 we compared a group of headache sufferers who consume large amounts of analgesic medications to headache sufferers who did not consume excessive analgesics. It was found that the two groups did not differ on age, duration of headache problem or gender. However, the groups did differ on subjective headache pain (with the high medicators experiencing more headache pain than low medicators) and diagnosis (with high medicators being more likely to have a muscle contraction component to their headaches). In an analysis of drug use within the high medication group, it was found that 91% were taking some kind of analgesic and that a majority (84%) were taking more than one type of medication. In Study 2 we found that the group of high medicators were not as successful in reducing headache activity as a result of a self-regulatory behavioral treatment as the matched controls. Furthermore, there was a direct relationship between reduction and treatment success in the high medication consuming population. Lastly, in Study 3 we examined the current psychological functioning of the two groups; no differences were found between the two groups indicating the lack of 'addictive' personality characteristics as an explanation for the high medicating population. These findings all support the existence of a sub-population of headache sufferers who consume excessive amounts of analgesic medication and who are relatively refractory to behavioral treatment.
“止痛药物反弹性头痛”的特征是个体对止痛药物产生适应性，服药后数小时头痛加剧，且停药后数周内头痛频率和强度显著增加。我们描述了三项旨在阐明这种推测的头痛综合征的存在及特征的研究。在研究1中，我们将一组大量服用止痛药物的头痛患者与未过量服用止痛药物的头痛患者进行了比较。结果发现，两组在年龄、头痛问题持续时间或性别方面没有差异。然而，两组在主观头痛疼痛方面（大量服药者比少量服药者经历更多的头痛疼痛）以及诊断方面（大量服药者的头痛更有可能伴有肌肉收缩成分）存在差异。在对大量服药组内的药物使用情况进行分析时发现，91%的人正在服用某种止痛药物，且大多数人（84%）服用不止一种药物。在研究2中，我们发现，与匹配的对照组相比，大量服药组通过自我调节行为治疗在减少头痛活动方面效果不佳。此外，在大量服药人群中，减少服药量与治疗成功之间存在直接关系。最后，在研究3中，我们检查了两组目前的心理功能；两组之间未发现差异，这表明不存在“成瘾性”人格特征来解释大量服药人群的情况。这些发现均支持存在一个过量服用止痛药物且对行为治疗相对难治的头痛患者亚群。
