Martinez Cameron I, Liktor-Busa Erika, Largent-Milnes Tally M
Department of Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, United States.
Front Neurol. 2024 Jan 30;15:1320791. doi: 10.3389/fneur.2024.1320791. eCollection 2024.
Primary headache disorders, such as migraine, account for a significant portion of disability rates worldwide, yet patients still struggle to receive the adequate medical and emotional support necessary to improve health outcomes. Insufficient pain management through either impractical pharmaceutical treatments or absent emotional support networks can worsen physical and mental health outcomes since comorbidities commonly associated with headache include hypertension, diabetes, depression, and anxiety. A lack of awareness on headache pathology and its observable severity can lead to pain-related prejudice that destroys beneficial aspects of patient self-advocacy and self-efficacy, thus potentially discouraging the use of healthcare services in favor of maladaptive coping skills. Acute treatments for primary headache disorders include non-steroidal anti-inflammatory drugs (i.e., aspirin, ibuprofen), triptans (i.e., sumatriptan), and opioids; however, continuous use of these pain-relieving agents can generate a secondary headache known as medication overuse headache (MOH). Recent work highlighting the overlap of morphological and functional brain changes in MOH and substance use disorder (SUD) suggests that insufficient pain management encourages analgesic misuse. The LGBTQ+ community-specifically transgender and gender non-conforming persons-struggles with high rates of mental illness and substance abuse. Since gender-affirming sex hormone therapy influences migraine progression, transgender and gender non-conforming (trans*) patients on hormone therapy have a higher risk for worsening migraine symptoms. However, trans* patients are less likely to have access to appropriate pain management techniques, thus preventing positive health outcomes for this vulnerable population.
原发性头痛疾病，如偏头痛，在全球致残率中占很大比例，但患者仍难以获得改善健康状况所需的足够医疗和情感支持。通过不实用的药物治疗或缺乏情感支持网络进行的疼痛管理不足，会使身心健康状况恶化，因为通常与头痛相关的合并症包括高血压、糖尿病、抑郁症和焦虑症。对头痛病理及其可观察到的严重程度缺乏认识，可能导致与疼痛相关的偏见，这种偏见会破坏患者自我主张和自我效能的有益方面，从而可能阻碍患者使用医疗服务，而倾向于采用适应不良的应对技巧。原发性头痛疾病的急性治疗方法包括非甾体抗炎药（如阿司匹林、布洛芬）、曲坦类药物（如舒马曲坦）和阿片类药物；然而，持续使用这些止痛剂会引发一种继发性头痛，称为药物过量使用性头痛（MOH）。最近的研究强调了MOH和物质使用障碍（SUD）在形态学和功能性脑变化方面的重叠，这表明疼痛管理不足会助长镇痛药物的滥用。LGBTQ+群体，特别是跨性别者和性别不一致者，面临着高比率的精神疾病和药物滥用问题。由于性别确认性激素疗法会影响偏头痛的进展，接受激素治疗的跨性别者和性别不一致（trans*）患者偏头痛症状恶化的风险更高。然而，trans*患者获得适当疼痛管理技术的可能性较小，从而阻碍了这一弱势群体获得积极的健康结果。
