Juliana H VanderPluym, Nan Cheng, Ye Zhu, Zhen Wang, Cynthia Morris, Andrew Jones, Amy A Gelfand, Jesssica Gautreaux
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引用次数: 0
Abstract
Objective: To examine the effectiveness of treatment strategies for medication-overuse headache (MOH) in children and adolescents.
Background: There are no guidelines for the treatment of adult or pediatric patients with MOH. However, research pertaining to MOH in adults is far outpacing research in children and adolescents.
Methods: A systematic review of evidence on treatment for MOH in children and adolescents was performed via PubMed, Embase, Web of Science, PsycINFO, and Cochrane from database inception to October 2024 for articles with the subject headings and keywords for MOH and pediatric, children, and/or adolescent. Inclusion criteria were: (i) randomized controlled trials and retrospective and prospective observational studies, (ii) children and adolescents aged <18 years with chronic headaches and with medication overuse (MO) or MOH, and (iii) interventions addressing MO or MOH, including pharmacologic and behavioral interventions. At least two independent reviewers screened citations and full-text articles independently.
Results: A total of 16 studies (one randomized control trial, six prospective observational studies and nine retrospective observational studies) were identified as meeting final inclusion criteria, resulting in 7978 total participants with a subset of those having MO, MOH or probable MOH. Participants ranged in mean age from 10 to 14.7 years, with 7.1%-46.2% male participants. All the studies recruited patients from an outpatient setting. Interventions used in the studies included withdrawal of the overused acute medication, initiation of preventive medication, patient education, physiotherapy and psychological treatment, and motivational interviewing. Multimodal therapy was studied more than single therapeutic intervention. There was vast heterogeneity across the studies, including study design, diagnostic criteria, intervention type, and outcomes.
Conclusion: From the data available, there does not seem to be a singular superior treatment approach. Accordingly, the most appropriate treatment modality will need to be tailored to the patient and their caregivers. Further research is required regarding management of MOH in children and adolescents.
目的：探讨儿童和青少年药物过度使用性头痛（MOH）的治疗策略的有效性。背景：目前尚无成人或儿童MOH患者的治疗指南。然而，与成人卫生部有关的研究远远超过了对儿童和青少年的研究。方法：通过PubMed、Embase、Web of Science、PsycINFO和Cochrane对儿童和青少年MOH治疗的证据进行系统回顾，从数据库建立到2024年10月，检索主题标题和关键词为MOH和儿科、儿童和/或青少年的文章。纳入标准为：(i)随机对照试验、回顾性和前瞻性观察性研究；（ii）年龄较大的儿童和青少年。结果：共有16项研究（1项随机对照试验、6项前瞻性观察性研究和9项回顾性观察性研究）被确定为符合最终纳入标准，总共有7978名参与者，其中一部分为MOH、MOH或可能MOH。参与者的平均年龄在10岁到14.7岁之间，其中7.1%-46.2%为男性。所有的研究都是从门诊病人中招募的。研究中使用的干预措施包括停止过度使用的急性药物，开始预防性药物治疗，患者教育，物理治疗和心理治疗以及动机访谈。多模式治疗的研究多于单一治疗干预。这些研究存在巨大的异质性，包括研究设计、诊断标准、干预类型和结果。结论：从现有的数据来看，似乎没有单一的优越治疗方法。因此，最合适的治疗方式需要针对患者及其护理人员量身定制。需要对儿童和青少年的卫生管理进行进一步研究。
期刊介绍：
Headache publishes original articles on all aspects of head and face pain including communications on clinical and basic research, diagnosis and management, epidemiology, genetics, and pathophysiology of primary and secondary headaches, cranial neuralgias, and pains referred to the head and face. Monthly issues feature case reports, short communications, review articles, letters to the editor, and news items regarding AHS plus medicolegal and socioeconomic aspects of head pain. This is the official journal of the American Headache Society.
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