Hellenic Headache Society, Athens, Greece.
Attikon University Hospital, Chaidari, Greece.
Cephalalgia. 2023 Jun;43(6):3331024231184909. doi: 10.1177/03331024231184909.
To estimate the prevalence and burden of medication overuse headache in a representative sample of the Greek population, aged 18-70 years old.
This is a cross-sectional descriptive observational study performed by quantitative computer-assisted telephone interviews, using a standardized 37-item questionnaire for headaches. The prevalence of medication overuse headache was estimated in the general population and compared within the groups formed by factors such as age, gender, diagnosis of headache type, prophylactic treatment used, geographical regions, social class, workdays lost and loss of productivity.
1197 (12.0%) participants reported headaches affecting performance out of 10,008 interviewees. The estimated prevalence of medication overuse headache in the general population was 0.7% (95% CI: 0.5-0.9). The female to male ratio was 3.6:1. The proportion of medication overuse headache was largest in the 35-54 age group, followed by the over 55 group. The Aegean islands and Crete were the regions with the highest proportion of medication overuse headache. Among participants with headaches, the proportion of medication overuse headache was 5.8% (95% CI: 4.4%-7.1%); 6.3% (95% CI: 4.7%-7.9%) among females and 4.4% (95% CI: 2.2%-6.6%) among males. In the same headache group, the proportion of medication overuse headache by prophylactic treatment for headache was 19.0% (95% CI: 9.5%-29.1%) for recipients and 5.0% (95% CI: 3.8-6.3) for non-recipients. The mean absenteeism in people with medication overuse headache was 1.0 days/month (95% CI: 0.4-1.6) and the mean presenteeism 6.3 days/month (95% CI: 3.9-8.7). The social class stratification showed a significant effect between the medication overuse headache in the sample of the general population and the C2 class, corresponding to skilled manual labour (OR: 0.7, CI: 0.5-0.9). In people with chronic migraine, and chronic tension type headache, as differentiated by the 37-item questionnaire, the proportion of medication overuse headache in the headache group estimated to be 50.5% (95% CI: 40.8%-60.1%) and 45.9%, (95% CI: 29.9%-62.0%) respectively. The group of people with acute headache medication overuse fulfilling the rest of the diagnostic criteria for medication overuse headache, except from the number of headache days per month (≥15 days/month), had a prevalence of 2.0% (95% CI: 1.75-2.30) and a proportion of 17.0% (95% CI: 14.8%-19.1%) among people with headache. In the episodic types of headache, the proportion of acute headache medication overuse was higher in the subgroup of people with high frequency episodic migraine, 24.9% (95% CI: 18.8%-31.0%), while it was 10.8% (95% CI: 8.2%-13.5%), for the low frequency episodic migraine and 8.5% (95% CI: 5.5%-10.4%), for the episodic tension type headache.
The prevalence of medication overuse headache in the general population in Greece and its proportion among the people with headache belongs to the lower part of the range of the reported literature, while the 3.6:1 female to male ratio is in agreement with it. In the same line, the impact of absenteeism and presenteeism on the workplace renders the condition alarming socio-economic health problem demanding immediate health policy planning.
在希腊代表性的 18-70 岁人群中，估计药物过度使用性头痛的患病率和负担。
这是一项横断面描述性观察研究，通过定量计算机辅助电话访谈进行，使用了一个标准化的 37 项头痛问卷。在一般人群中估计药物过度使用性头痛的患病率，并根据年龄、性别、头痛类型诊断、使用的预防性治疗、地理位置、社会阶层、工作日损失和生产力损失等因素进行比较。
在 10008 名受访者中，有 1197 人（12.0%）报告头痛影响了他们的表现。一般人群中药物过度使用性头痛的估计患病率为 0.7%（95%可信区间：0.5-0.9）。女性与男性的比例为 3.6:1。35-54 岁年龄组药物过度使用性头痛的比例最大，其次是 55 岁以上组。爱琴海岛屿和克里特岛是药物过度使用性头痛比例最高的地区。在有头痛的参与者中，药物过度使用性头痛的比例为 5.8%（95%可信区间：4.4%-7.1%）；女性为 6.3%（95%可信区间：4.7%-7.9%），男性为 4.4%（95%可信区间：2.2%-6.6%）。在同一头痛组中，接受预防性治疗的参与者中药物过度使用性头痛的比例为 19.0%（95%可信区间：9.5%-29.1%），未接受预防性治疗的比例为 5.0%（95%可信区间：3.8%-6.3%）。药物过度使用性头痛患者的平均缺勤天数为 1.0 天/月（95%可信区间：0.4-1.6），平均出勤天数为 6.3 天/月（95%可信区间：3.9-8.7）。社会阶层分层显示，在一般人群中药物过度使用性头痛的样本与熟练工人（OR：0.7，95%可信区间：0.5-0.9）对应的 C2 类之间存在显著影响。在慢性偏头痛和慢性紧张型头痛患者中，根据 37 项问卷进行区分，头痛组中药物过度使用性头痛的比例估计为 50.5%（95%可信区间：40.8%-60.1%）和 45.9%（95%可信区间：29.9%-62.0%）。符合除每月头痛天数（≥15 天/月）以外的药物过度使用性头痛诊断标准的急性头痛药物过度使用者，其患病率为 2.0%（95%可信区间：1.75-2.30），比例为 17.0%（95%可信区间：14.8%-19.1%）。在发作性头痛类型中，高频发作性偏头痛亚组的急性头痛药物过度使用比例较高，为 24.9%（95%可信区间：18.8%-31.0%），而低频发作性偏头痛为 10.8%（95%可信区间：8.2%-13.5%），发作性紧张型头痛为 8.5%（95%可信区间：5.5%-10.4%）。
希腊一般人群中药物过度使用性头痛的患病率及其在头痛患者中的比例属于报告文献范围的较低部分，而 3.6:1 的女性与男性比例与之相符。同样，缺勤和出勤对工作场所的影响使这种情况成为一个令人震惊的社会经济健康问题，需要立即进行卫生政策规划。
