Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan; University Hospital, Taipa, Macau.
Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, Memory and Aging Centre, University of California, San Francisco, CA, United States.
Prog Brain Res. 2020;255:371-402. doi: 10.1016/bs.pbr.2020.05.019. Epub 2020 Jun 19.
Medication overuse headache (MOH), previously known as analgesic abuse headache or medication misuse headaches, is a common form of chronic headache disorder that has a detrimental impact on health and society. Although it has been widely accepted that overusing abortive medications is paradoxically the cause of MOH and drug discontinuation is the treatment of choice, ongoing debates exist as to whether drug consumption per se is the cause or consequence of headache chronification. Certain features in MOH such as their compulsive drug-seeking behavior, withdrawal headaches and high relapse rates share similarities with drug dependence, suggesting that there might be common underlying biological and psychobehavioral mechanisms. In this regard, this article will discuss the updated evidence and current debates on the possible biobehavioral overlap between MOH and drug dependence. To begin with, we will discuss whether MOH has characteristics of substance dependence based on standard psychiatry diagnostic criteria and other widely used dependence scales. Recent epidemiological studies underscoring common psychiatric comorbidities between the two disorders will also be presented. Although both demonstrate seemingly distinct personality traits, recent studies revealed similar decision-making impairment from a cognitive perspective, indicating the presence of a maladaptive reward system in both disorders. In addition, emerging imaging studies also support this notion by showing reversible morphological and functional brain changes related to the mesocorticolimbic reward circuitry in MOH, with a strong resemblance to those in addiction. Finally, an increased familial risk for drug dependence and genetic association with dopaminergic and drug dependence molecular pathways in MOH also support a possible link between MOH and addiction. Understanding the role of dependence in MOH will have a great impact on disease management as this will provide the missing piece of the puzzle in current therapeutic strategies.
药物过度使用性头痛（MOH），以前称为镇痛药滥用性头痛或药物滥用性头痛，是一种常见的慢性头痛障碍，对健康和社会都有不利影响。尽管人们普遍认为过度使用止痛药物是 MOH 的原因，停药是治疗的首选，但关于药物本身是否是头痛慢性化的原因或后果仍存在争议。MOH 中的某些特征，如强迫性觅药行为、戒断性头痛和高复发率，与药物依赖相似，这表明可能存在共同的潜在生物学和心理行为机制。在这方面，本文将讨论 MOH 和药物依赖之间可能存在的生物行为重叠的最新证据和当前争议。首先，我们将讨论根据标准精神病学诊断标准和其他广泛使用的依赖量表，MOH 是否具有物质依赖的特征。最近的流行病学研究强调了这两种疾病之间常见的精神共病，也将在本文中呈现。尽管两者都表现出明显不同的人格特征，但最近的研究从认知的角度揭示了相似的决策障碍，表明两种疾病都存在适应性不良的奖励系统。此外，新兴的影像学研究也通过显示与 MOH 中中皮质边缘奖励回路相关的形态和功能脑变化来支持这一观点，这些变化与成瘾中的变化非常相似。最后，MOH 中药物依赖的家族风险增加以及与多巴胺能和药物依赖分子途径的遗传关联也支持 MOH 与成瘾之间的可能联系。理解依赖在 MOH 中的作用将对疾病管理产生重大影响，因为这将为当前治疗策略中缺失的部分提供答案。
