Division of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
Curr Pain Headache Rep. 2018 Aug 27;22(11):71. doi: 10.1007/s11916-018-0729-x.
The aim is twofold. First, to give an insight on the role exerted by different classes of drugs in favouring migraine chronification. Second, to explore the relationship between type and amount of overused medications and history of previous withdrawal treatment and of frequent relapses.
All drug classes were found to favour migraine chronification. No data are available for the association with relapses into CM-MOH. Our clinical study shows that patients who underwent previous withdrawal treatments were more likely to be overusers of multiple drug classes and overuse higher amounts of symptomatic medications, particularly, indomethacin, eletriptan and tramadol. Frequent relapsers were more likely to be overusers of opioids or ergotamine and caffeine derivates or of multiple classes, particularly acetylsalicylic acid and ergotamine/caffeine derivates. The joint results our review and clinical study do not seem to support the idea that MOH is drug-specific: rather, it points out that all drug classes may induce migraine chronification. Those drugs which are at higher risk of overuse are among those preferred by the "worst" patients, i.e. those who needed one or more withdrawal treatments for MOH. Our results reinforce the clinical impression that patients with CM and MOH, and particularly the most difficult to treat for their poor response to withdrawal treatments, are characterised by a particular drive towards the consumption of "whatever is likely to be perceived to provide some relief", despite these drugs that are perceived as "more powerful", are often indicated as second- or third-line medications.
本文旨在阐明以下两方面内容：第一，不同类别的药物在促进偏头痛慢性化中所起的作用。第二，探讨药物滥用类型和数量与先前撤药治疗史和频繁复发之间的关系。
所有类别的药物都被发现有利于偏头痛慢性化。目前尚无数据表明与 CM-MOH 复发有关。我们的临床研究表明，接受过先前撤药治疗的患者更有可能过度使用多种药物类别，并过度使用更多数量的对症药物，特别是吲哚美辛、依来曲普坦和曲马多。频繁复发者更有可能过度使用阿片类药物或麦角胺和咖啡因衍生物，或过度使用多种药物类别，特别是乙酰水杨酸和麦角胺/咖啡因衍生物。我们的综述和临床研究的联合结果似乎并不支持 MOH 是特定药物的观点：相反，它指出所有药物类别都可能导致偏头痛慢性化。那些更容易被过度使用的药物，是那些最容易被“最糟糕”的患者选择的药物，即那些因 MOH 而需要一次或多次撤药治疗的患者。我们的研究结果进一步证实了临床印象，即患有 CM 和 MOH 的患者，尤其是那些对撤药治疗反应不佳、治疗难度较大的患者，往往有一种特殊的冲动，想要使用“任何可能被认为能提供一些缓解的药物”，尽管这些被认为“更有效”的药物通常被作为二线或三线药物。
