Toom Kati, Braschinsky Mark, Obermann Mark, Katsarava Zara
Neurology Clinic, Tartu University Hospital, Tartu, Estonia.
Estonian Headache Society, Tartu, Estonia.
Cephalalgia. 2021 Apr;41(4):443-452. doi: 10.1177/0333102420942238. Epub 2020 Aug 20.
Secondary headaches attributed to exposure to or the overuse of a substance are classified under chapter eight in the International Classification of Headache Disorders 3rd edition. Three distinct sub-chapters consider: 1. Headache attributed to exposure to a substance, 2. Medication overuse headache, and 3. Headache attributed to substance withdrawal. Headache attributed to exposure to a substance refers to a headache with onset immediately or within hours after the exposure, while medication overuse headache is a headache occurring on 15 or more days per month that has developed as a consequence of regular usage of acute headache medication(s) for more than three consecutive months in a patient with a pre-existing primary headache disorder. The withdrawal of caffeine, oestrogen, and opioids is most often associated with the development of headache.
Despite the current headache classification, there is no certainty of a causal relationship between the use of any substance and the development of headache. Some substances are likely to provoke headache in patients that suffer from a primary headache disorder like migraine, tension-type headache or cluster headache, while others were described to cause headache even in people that generally do not get headaches. Toxic agents, such as carbon monoxide (CO) are difficult to investigate systematically, while other substances such as nitric oxide (NO) were specifically used to induce headache experimentally. If a patient with an underlying primary headache disorder develops a headache, in temporal relation to exposure to a substance, which is significantly worse than the usual headache it is considered secondary. This is even more the case if the headache phenotype is different from the usually experienced headache characteristics. Medication overuse headache is a well-described, distinct disease entity with only marginally understood pathophysiology and associated psychological factors. Managing medication overuse headache patients includes education, detoxification, prophylactic treatments and treating comorbidities, which is reflected in available guidelines. Viewing medication overuse headache as a separate entity helps clinicians and researchers better recognise, treat and study the disorder.
Identification of substances that may cause or trigger secondary headache is important in order to educate patients and health care professionals about potential effects of these substances and prevent unnecessary suffering, as well as deterioration in quality of life. Treatment in case of medication overuse and other chronic headache should be decisive and effective.
归因于物质接触或过度使用的继发性头痛在《国际头痛疾病分类》第三版第八章中分类。三个不同的子章节涉及：1. 归因于物质接触的头痛，2. 药物过量使用性头痛，3. 归因于物质戒断的头痛。归因于物质接触的头痛是指在接触后立即或数小时内发作的头痛，而药物过量使用性头痛是指每月15天或更多天出现的头痛，这是在患有原发性头痛疾病的患者中连续三个月以上定期使用急性头痛药物的结果。咖啡因、雌激素和阿片类药物的戒断最常与头痛的发生相关。
尽管有当前的头痛分类，但任何物质的使用与头痛发生之间的因果关系并不确定。一些物质可能会在患有原发性头痛疾病（如偏头痛、紧张型头痛或丛集性头痛）的患者中引发头痛，而其他物质即使在通常不头痛的人群中也被描述为会引起头痛。有毒物质（如一氧化碳）难以进行系统研究，而其他物质（如一氧化氮）则专门用于实验性诱导头痛。如果患有潜在原发性头痛疾病的患者出现头痛，且与物质接触在时间上相关，且比通常的头痛严重得多，则被视为继发性头痛。如果头痛表型与通常经历的头痛特征不同，则更是如此。药物过量使用性头痛是一种描述明确、独特的疾病实体，其病理生理学和相关心理因素仅得到有限的理解。管理药物过量使用性头痛患者包括教育、解毒、预防性治疗和治疗合并症，这在现有指南中有所体现。将药物过量使用性头痛视为一个单独的实体有助于临床医生和研究人员更好地识别、治疗和研究该疾病。
识别可能导致或引发继发性头痛的物质很重要，以便向患者和医疗保健专业人员宣传这些物质的潜在影响，预防不必要的痛苦以及生活质量的下降。对于药物过量使用和其他慢性头痛的治疗应果断且有效。
