Continuum (Minneap Minn). 2024 Apr 1;30(2):379-390. doi: 10.1212/CON.0000000000001403.
Medication-overuse headache (MOH) has been described for almost 100 years and is characterized as a daily or near-daily headache that usually presents in patients with preexisting primary headache disorders who are overusing one or more acute or symptomatic headache medications. This article reviews the diagnosis and management of patients with MOH.
The International Classification of Headache Disorders criteria for MOH have changed over time. The worldwide prevalence appears to be between 1% and 2%. Together, headache disorders, including MOH, are currently ranked as the second leading cause of years lived with disability in the Global Burden of Disease world health survey. Significant neurophysiologic changes are seen in the brains of patients with MOH, including functional alterations in central pain processing and modulating systems and central sensitization. Research supports updates to the principles of management, including weaning off the overused medication, preventive therapy, biobehavioral therapy, and patient education.
MOH is a fairly common and treatable secondary headache disorder that produces significant disability and a substantial reduction in quality of life. The costs related to lost income and disability are substantial. MOH is intimately related to chronic migraine, which continues to be underrecognized and undertreated. Treatment focuses on both the institution of effective preventive migraine therapy and the reduction or removal of the overused medications. Educational efforts directed toward both providers and patients have been shown to be effective in reducing the effect of MOH.
药物过度使用性头痛（MOH）已有近 100 年的描述，其特征为每日或接近每日头痛，通常发生在过度使用一种或多种急性或对症头痛药物的原发性头痛障碍患者中。本文回顾了 MOH 患者的诊断和治疗。
国际头痛疾病分类标准（ICHD）中 MOH 的诊断标准随时间发生了变化。全球患病率似乎在 1%至 2%之间。包括 MOH 在内的头痛障碍目前在全球疾病负担世界卫生调查中被列为导致残疾年数的第二大原因。MOH 患者的大脑出现明显的神经生理变化，包括中枢疼痛处理和调节系统以及中枢敏化的功能改变。研究支持管理原则的更新，包括逐渐减少过度使用的药物、预防性治疗、生物行为治疗和患者教育。
MOH 是一种较为常见且可治疗的继发性头痛障碍，可导致严重残疾和生活质量显著下降。相关的收入损失和残疾成本巨大。MOH 与慢性偏头痛密切相关，但后者仍未得到充分认识和治疗。治疗侧重于建立有效的预防性偏头痛治疗和减少或消除过度使用的药物。针对提供者和患者的教育努力已被证明可有效减少 MOH 的影响。
