Headache Science Center, IRCCS Mondino Foundation, Pavia, Italy.
Neurocenter of Southern Switzerland (NSI), Headache Center, Regional Hospital Lugano, Lugano, Switzerland.
Headache. 2019 Oct;59(9):1481-1491. doi: 10.1111/head.13641. Epub 2019 Oct 3.
The International Classification of Headache Disorders lists different subtypes of medication overuse headache (MOH), according to the medication overused. The aim of this study is to evaluate whether the different subtypes correspond to clinically distinguishable phenotypes in a large population.
This descriptive cross-sectional observational study included 660 patients with MOH referred to headache centers in Europe and Latin America as a part of the COMOESTAS project. Information about clinical features was collected with structured patient interviews and with self-administered questionnaires for measuring disability, anxiety, and depression.
Female/male ratio, body mass index, marital status, and level of education were similar among in subjects enrolled in the 5 centers. The mean age was higher among subjects overusing triptans (T-MOH) with respect to subjects overusing simple analgesic (A-MOH). Duration of headache before chronification was longer in T-MOH (19.2 ± 11.9 years) and in subjects overusing ergotamines (E-MOH, 17.8 ± 11.7 years) with respect to the A-MOH group (13.1 ± 10.9; P < .001 and P = .017, respectively) and in T-MOH with respect multiple drug classes (M-MOH, 14.9 ± 11.7; P = .030). Migraine Disability Assessment (MIDAS) score was significantly lower in E-MOH group (33.6 ± 41.6), while T-MOH group (56.8 ± 40.6) had a significant lower MIDAS score with respect to M-MOH (67.2 ± 62.5; P = .016 and P = .037, respectively). Prevalence of depression and anxiety was lower in patients overusing T with respect to other groups of patients (χ = 10.953, P = .027 and χ = 25.725, P < .001, respectively).
In this study on a large and very well characterized population of MOH, we describe the distinctive clinical characteristics of MOH subtypes. These findings contribute to more clearly define the clinical picture of a poorly delineated headache disorder. They also provide some insights in the possible trajectories leading to this highly disabling chronic headache, that is classified as a secondary form, but whose occurrence is entirely dependent on an underlying primary headache.
根据药物过度使用的药物种类，《国际头痛疾病分类》列出了不同类型的药物过度使用性头痛（MOH）。本研究的目的是评估在一个大样本中，不同的亚型是否对应于临床上可区分的表型。
这是一项描述性的、横断面的观察性研究，共纳入了欧洲和拉丁美洲头痛中心的 660 名 MOH 患者，该研究是 COMOESTAS 项目的一部分。通过结构化的患者访谈和自我管理的问卷，收集了有关临床特征的信息，用于测量残疾、焦虑和抑郁程度。
在参加 5 个中心研究的患者中，女性/男性比例、体重指数、婚姻状况和教育水平相似。与使用简单镇痛药（A-MOH）过度的患者相比，使用曲坦类药物（T-MOH）过度的患者的平均年龄更高。与 A-MOH 组相比，T-MOH（19.2±11.9 年）和使用麦角胺类药物（E-MOH，17.8±11.7 年）患者的慢性头痛前病程更长（13.1±10.9 年；P<0.001 和 P=0.017），与多药类药物（M-MOH，14.9±11.7 年）相比，T-MOH 患者的病程也更长（P=0.030）。E-MOH 组的偏头痛残疾评估（MIDAS）评分显著较低（33.6±41.6），而 T-MOH 组（56.8±40.6）的 MIDAS 评分与 M-MOH 组（67.2±62.5）相比显著较低（P=0.016 和 P=0.037）。与其他组患者相比，使用 T 药物过度的患者中抑郁和焦虑的患病率较低（X²=10.953，P=0.027 和 X²=25.725，P<0.001）。
在这项针对 MOH 患者的大型、特征明确的研究中，我们描述了 MOH 亚型的独特临床特征。这些发现有助于更清楚地定义这种定义不明确的头痛障碍的临床特征。它们还为导致这种高度致残的慢性头痛（被归类为继发性头痛，但发生完全取决于潜在的原发性头痛）的可能轨迹提供了一些见解。
