药物过度使用头痛:来自疼痛医学临床队列的结果

L. Moskatel
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引用次数: 2

摘要

背景与目的:药物过度使用头痛(MOH)是一种常见的、致残性的、可治疗的慢性日常头痛病因。本研究评估了一组在疼痛医学诊所就诊的MOH患者的特征。方法:我们对加州大学圣地亚哥分校疼痛医学门诊的神经科医生所见的连续患者进行了回顾性研究。统计资料、头痛诊断和过度用药从83例≥18岁患者的临床记录中提取,这些患者的MOH诊断于2017年9月12日至2020年3月30日输入电子病历。结果:阿片类药物是滥用最多的药物(42/83,50.6%),其次是含咖啡因类药物(20/83,24.1%)、曲坦类药物(12/83,14.5%)和非甾体类抗炎药(10/83,12.9%)。慢性偏头痛是最常见的潜在头痛综合征(54/83,65.1%),其次是继发性头痛障碍(13/83,15.7%)和紧张性头痛(8/83,9.6%)。男性更可能过度使用阿片类药物(OR 3.3, p = 0.026),而女性更可能过度使用含咖啡因的化合物(OR 5.4, p = 0.041)。讨论和结论:疼痛专家在疼痛临床环境中认识到MOH是至关重要的。阿片类药物过度使用导致的头痛在男性中更为常见,部分原因可能是男性对偏头痛的认识不足,因此没有接受针对偏头痛的药物治疗。过量使用含咖啡因的化合物在女性中更为常见;这些是非处方药(OTC),通常不会出现在患者的药物清单上。疼痛专家应该明确询问头痛患者是否正在使用OTC含咖啡因的化合物。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Medication-Overuse Headache: Results from a Pain Medicine Clinic Cohort
Background and Objective: Medication-overuse headache (MOH) is a common, disabling, and treatable cause of chronic daily headache. This study evaluates the characteristics of a cohort of patients with MOH seen in a pain medicine clinic. Methods: We conducted a retrospective study of consecutive patients seen by a neurologist in the pain medicine clinic at the University of California, San Diego. Demographics, headache diagnoses, and overused medications were extracted from clinical records from 83 patients ≥ 18 years of age where a diagnosis of MOH was entered into the electronic medical record September 12, 2017-March 30, 2020. Results: Opioids were the most overused medications (42/83, 50.6%) followed by caffeine-containing compounds (20/83, 24.1%), triptans (12/83, 14.5%) and non-steroidal anti-inflammatory drugs (10/83, 12.9%). Chronic migraine was the most common underlying headache syndrome (54/83, 65.1%), followed by secondary headache disorder (13/83, 15.7%) and tension-type headache (8/83, 9.6%). Men were more likely to be overusing opioids (OR 3.3, p = 0.026) while women were more likely to be overusing caffeine-containing compounds (OR 5.4, p = 0.041). Discussion and Conclusions: It is crucial for pain specialists to recognize MOH in the pain clinic setting. Opioid overuse headache is more common among men, likely in part due to migraine being underrecognized in men and therefore men not receiving migraine-specific medications. Caffeine-containing compound overuse is more common among women; these are over-the-counter (OTC) and often do not appear on patients’ medications lists. Pain specialists should specifically ask patients with headache whether they are using OTC caffeine-containing compounds.
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