Department of Neurology, Krankenhaus Hietzing mit Neurologischem Zentrum [General Hospital Hietzing with Neurological Center] Rosenhügel, Vienna, Austria.
Department of Neurology, Medical University of Vienna, Vienna, Austria.
Cephalalgia. 2020 Jul;40(8):808-817. doi: 10.1177/0333102420911210. Epub 2020 Mar 10.
Definitions of medication overuse headache have changed over time.
To evaluate the clinical characteristics of medication overuse headache patients admitted for inpatient withdrawal therapy over a period of 32 years.
We included all patients with medication overuse headache treated from 1 January 1984 to 31 December 2015. We obtained all data from the medical reports and defined three periods, P1 (1984-1993), P2 (1994-2003), and P3 (2004-2015). The -value adjusted for multiple comparisons was set to 0.005.
Within 32 years, a total of 787 patients accounted for 904 admissions for MOH. From P1 to P3, the proportion of patients with preexisting migraine increased from 44.3% to 53.3% (chi = 9.0, = 0.01) and that with preexisting tension-type headache decreased from 47.9% to 34.6% (chi = 9.3, < 0.01). The median time since onset of headache and medication overuse headache decreased from 20 to 15 years ( < 0.001) and from 3 to 2 years ( < 0.001). The median cumulative number of single doses decreased from 120 to 90 per month ( = 0.002). Overuse of triptans, non-opioid analgesics, and opioids increased, whereas overuse of ergotamines decreased over time ( < 0.001 for all tests). The use of prophylactic medication before admission increased from 8.3% to 29.9% (chi = 89.5, < 0.001).
This retrospective study in a large number of patients with medication overuse headache admitted for inpatient withdrawal therapy over a period of 32 years shows a trend towards changes in the preexisting headache type, a decrease in the time since onset of headache and medication overuse headache, a decrease in the number of drug doses used per month, changes in the type of drugs overused, and an increase in, but still low rate, of prophylactic medication prior to admission.
药物过度使用性头痛的定义随时间而变化。
评估在 32 年期间接受住院戒断治疗的药物过度使用性头痛患者的临床特征。
我们纳入了自 1984 年 1 月 1 日至 2015 年 12 月 31 日期间接受治疗的所有药物过度使用性头痛患者。我们从病历中获取了所有数据，并定义了三个时期，P1（1984-1993 年）、P2（1994-2003 年）和 P3（2004-2015 年）。多重比较校正的 p 值设为 0.005。
在 32 年期间，共有 787 名患者，共 904 人次因 MOH 住院。从 P1 到 P3，原有偏头痛患者的比例从 44.3%增加到 53.3%（卡方=9.0，p=0.01），原有紧张型头痛患者的比例从 47.9%减少到 34.6%（卡方=9.3，p<0.01）。头痛和药物过度使用性头痛的发病时间中位数从 20 年减少到 15 年（p<0.001），从 3 年减少到 2 年（p<0.001）。每月单药累积剂量中位数从 120 次减少到 90 次（p=0.002）。曲坦类、非阿片类镇痛药和阿片类药物的过度使用增加，而麦角胺类药物的过度使用减少（所有检验均 p<0.001）。入院前预防性药物的使用从 8.3%增加到 29.9%（卡方=89.5，p<0.001）。
这项回顾性研究纳入了大量因药物过度使用性头痛而住院接受戒断治疗的患者，研究显示，原有头痛类型、头痛和药物过度使用性头痛发病时间、每月药物剂量、过度使用药物类型的变化趋势以及入院前预防性药物的使用虽有所增加，但仍处于较低水平。
