背景:药物过度使用性头痛(MOH)在原发性头痛疾病患者中非常普遍。
目的:(1)提供流行病学的最新信息,危险因素,和MOH的治疗策略;(2)为MOH的管理提供建议。
结果:MOH的患病率为0.5-7.2%。MOH的危险因素包括女性,较低的社会经济地位,一些精神病,和物质使用障碍,在其他人中。最近的大型临床试验支持预防性治疗作为MOH管理的一个组成部分。新兴的临床试验证据支持抗CGRPmAb作为偏头痛和MOH患者的有效预防性治疗。在大型临床试验中,坎地沙坦,托吡酯,阿米替林,和onabotulinumtoxinA是最常用的预防性疗法,为这些代理商提供进一步的支持。MOH管理需要多方面和以患者为中心的方法,涉及患者教育,行为干预,撤回过度使用的药物,并开始预防性药物治疗。
Medication overuse headache (MOH) is highly prevalent among individuals with primary headache disorders.
(1) Provide an update on epidemiology, risk factors, and treatment strategies of MOH and (2) provide recommendations on the management of MOH.
The prevalence of MOH ranges from 0.5 to 7.2%. Risk factors for MOH include female sex, lower socioeconomic status, some psychiatric conditions, and substance use disorders, among others. Recent large clinical trials support
preventative therapy as an integral component of MOH management. Emerging clinical trial evidence supports anti-CGRP mAbs as effective
preventative treatments among individuals with migraine and MOH. Among the large clinical trials, candesartan, topiramate, amitriptyline, and onabotulinumtoxinA were the most used
preventative therapies, providing further support for these agents. MOH management requires a multifaceted and patient-centered approach that involves patient education, behavioral interventions, withdrawal of the overused medication, and initiation of
preventative medication.