根据急性药物使用的类别，药物过度使用性头痛的临床特征：一项横断面多中心研究。

Clinical characteristics of medication-overuse headache according to the class of acute medication: A cross-sectional multicenter study.

机构信息

Department of Neurology, Jeonbuk National University Hospital & School of Medicine, Jeonju, South Korea.

Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea.

出版信息

Headache. 2022 Jul;62(7):890-902. doi: 10.1111/head.14363. Epub 2022 Jul 14.

DOI:10.1111/head.14363

PMID:35833500

Abstract

OBJECTIVE

To characterize the clinical features of patients with medication-overuse headache (MOH) according to the class of acute medications being overused.

BACKGROUND

MOH is a common global health problem, severely disabling the majority of the patients affected. Although various medications can cause MOH, whether clinical features differ according to the overused medication type remains unclear.

METHODS

We analyzed data from a multicenter cross-sectional study in neurology clinics in Korea from April 2020 to June 2021.

RESULTS

Among 229 eligible patients, MOH was documented in patients who overused multiple drug classes (69/229, 30.1%; most frequent occurrence), triptans (50/229, 21.8%), non-opioid analgesics (48/229, 21.0%), and combination-analgesics (40/229, 17.4%). Patients who overused multiple drug classes reported more frequent use of acute medications (median [25th-75th percentiles]: 25.0 [15.0-30.0] vs. 17.5 [10.0-25.5] days/month, p = 0.029) and fewer crystal-clear days (0.0 [0.0-9.5] vs. 9.0 [0.0-10.0] days/month, p = 0.048) than those who overused triptans. Patients who overused multiple drug classes also reported shorter intervals from chronic daily headache to the onset of MOH than patients who overused combination-analgesics (0.6 [0.2-1.9] vs. 2.4 [0.7-5.4] years, p = 0.001) or non-opioid analgesics (1.5 [0.6-4.3] years, p = 0.004). Patients who overused multiple drug classes reported more emergency room visits (1.0 [0.0-1.0] visits/year) than those who overused combination-analgesics (0.0 [0.0-1.0], p = 0.024) or non-opioid analgesics (0.0 [0.0-1.0], p = 0.030). Patients who overused triptans reported fewer headache days (21.0 [20.0-30.0] vs. 30.0 [20.5-30.0] days/month, p = 0.008) and fewer severe headache days (7.0 [4.0-10.0] vs. 10.0 [5.0-15.0] days/month, p = 0.017) than those who overused non-opioid analgesics.

CONCLUSIONS

Some clinical characteristics of MOH significantly differed according to the class of overused medications. The findings from this study may contribute to the understanding of the clinical characteristics and pathophysiology of MOH.

摘要

目的

根据滥用的急性药物类别，描述药物过度使用性头痛（MOH）患者的临床特征。

背景

MOH 是一个常见的全球性健康问题，严重影响了大多数受影响的患者。尽管各种药物都可能导致 MOH，但滥用药物类型是否存在临床差异尚不清楚。

方法

我们分析了 2020 年 4 月至 2021 年 6 月在韩国神经病学诊所进行的一项多中心横断面研究的数据。

结果

在 229 名符合条件的患者中，69 名（21.8%）患者记录了 MOH，这些患者过度使用了多种药物类别，50 名（21.8%）患者过度使用了曲坦类药物，48 名（21.0%）患者过度使用了非阿片类镇痛药，40 名（17.4%）患者过度使用了复方镇痛药。与过度使用曲坦类药物的患者相比，过度使用多种药物类别的患者报告了更频繁地使用急性药物（中位数[25 分位数-75 分位数]：25.0 [15.0-30.0] vs. 17.5 [10.0-25.5] 天/月，p = 0.029）和更少的“清亮”天数（0.0 [0.0-9.5] vs. 9.0 [0.0-10.0] 天/月，p = 0.048）。与过度使用复方镇痛药或非阿片类镇痛药的患者相比，过度使用多种药物类别的患者从慢性每日头痛到 MOH 发作的间隔也更短（0.6 [0.2-1.9] vs. 2.4 [0.7-5.4] 年，p = 0.001）或非阿片类镇痛药（1.5 [0.6-4.3] 年，p = 0.004）。与过度使用复方镇痛药的患者相比，过度使用多种药物类别的患者报告了更多的急诊就诊次数（1.0 [0.0-1.0] 次/年），而过度使用非阿片类镇痛药的患者（0.0 [0.0-1.0]，p = 0.030）或非阿片类镇痛药（0.0 [0.0-1.0]，p = 0.024）。与过度使用非阿片类镇痛药的患者相比，过度使用曲坦类药物的患者报告了更少的头痛天数（21.0 [20.0-30.0] vs. 30.0 [20.5-30.0] 天/月，p = 0.008）和更少的严重头痛天数（7.0 [4.0-10.0] vs. 10.0 [5.0-15.0] 天/月，p = 0.017）。