Drug Induced Refractory Headache ‐ Clinical Features and Management

Mathew, Ninan T.; Kurman, Rochelle; Pérez, Francisco José Hernández

doi:10.1111/j.1526-4610.1990.hed3010634.x

Cited by 258 publications

(210 citation statements)

References 1 publication

Supporting

Mentioning

194

Contrasting

Unclassified

Order By: Relevance

“…A associação entre o uso excessivo de MS e a menor responsividade ao tratamento observada nesses pacientes foi estatisticamente significativa (x 2 =87,2%; P<0,05) . A interrupção das MS foi um fator importante para a resposta à terapêutica instituída, o que está de acordo com o que se afirmava a literatura 12,13,18 .…”

Section: Discussionunclassified

See 1 more Smart Citation

Cefaléia crônica diária primária: a propósito de 52 casos

Jevoux¹,

Filho²,

Souza³

1998

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

RESUMO -Apesar de a cefaléia crônica diária (CCD) ser frequentemente observada na prática cefaliátrica, o interesse pelo seu estudo é recente. Foram estudados 52 pacientes (48 mulheres e 4 homens) com idade entre 13 e 71 anos, que preencheram os critérios diagnósticos propostos por Silberstein e col. (1994) para CCD primária. A análise das principais características clínicas permitiu o diagnóstico de três modalidades da CCD: migrânea transformada (n=39; 75%), cefaléia do tipo tensional crônica (n=11; 21,1%) e cefaléia diária persistente de início súbito (n=2; 3,9%). Destes pacientes, 34 (65,4%) utilizavam de modo excessivo medicações sintomáticas e foram considerados como sofredores de cefaléia induzida por drogas. O esquema de tratamento utilizado incluiu, além da orientação à interrupção das medicações sintomáticas, o uso de amitriptilina isoladamente ou em associação ao propranolol, em doses crescentes, levando-se em conta a resposta e a tolerância a estes fármacos. Esse esquema revelou-se eficaz na diminuição da frequência da cefaléia na maioria dos pacientes com CCD. Os efeitos benéficos revelaram-se duradouros, persistindo mesmo após seis meses do início do acompanhamento. Na minoria dos pacientes na qual a terapêutica instituída não obteve êxito, constatou-se, de forma estatisticamente significativa, a persistência do uso excessivo de medicações sintomáticas. PALAVRAS-CHAVE: cefaléia crônica diária, migrânea transformada, cefaléia do tipo tensional crônica, cefaléia diária persistente de início súbito, cefaléia induzida por drogas. Primary chronic daily headache : a report on 52 casesABSTRACT -Fifty-two patients (48 women, 4 men, ages varying between 13 and 71 years) that fulfilled the criteria by Silberstein et al. (1994) for chronic daily headache (CDH) were studied. The main clinical characteristics allowed three diagnostic types of CDH: transformed migraine (n=39; 75%); chronic tension-type headache (n=11; 21.1%); and new daily persistent headache (n=2; 3.9%). Thirty-four patients used to take symptomatic medication in excess and were considered as having drug-induced headache. The treatment included increasing doses of amitriptyline alone or associated with propranolol besides the interruption of the symptomatic medication. This scheme was effective to lower the frequency of headache in most CDH patients and its beneficial effects had lasted even six months after the beginning of the follow-up. In the few patients in which the treatment was unsuccessful, the persistence of abusive use of symptomatic drugs was statistically significant. KEY WORDS: chronic daily headache, transformed migraine, chronic tensional-type headache, new daily persistent headache, drug-induced headache.A designação cefaléia crônica diária (CCD) primária é utilizada para se referir a um grupo de cefaléias recorrentes, de ocorrência diária ou quase diária, frequentemente, contínuas ou quase contínuas e que persistem por meses ou anos 1 . Apesar de a CCD ser frequentemente observada na prática clínica, o interesse pelo seu estudo...

show abstract

Section: Discussionunclassified

“…No entanto, alguns pacientes apresentam, em certo momento da vida, perda das características marcantes da cefaléia de origem, dificultando o discrime entre as duas entidades 9,10 . Uma porcentagem significativa de sofredores de CCD utiliza quantidades excessivas de medicações sintomáticas (MS), o que pode contribuir para a perpetuação da dor 2,[11][12][13][14] .…”

unclassified

Cefaléia crônica diária primária: a propósito de 52 casos

Jevoux¹,

Filho²,

Souza³

1998

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…A fájdalomcsillapítók túlzott használata esetén kialakuló fejfájáshoz az epizodikus fejfájáshoz képest több kísérő tünet és komorbid állapot (gyengeség, hányinger, fáradékonyság, ingerlékenység, depresszió, koncentrá-ciós és memóriazavar [20], szorongás és hangulatzavar [21], a koffeintartalmú analgetikumok által kiváltott alvászavar) társul [18]. Azon ismert tény, hogy a krónikus fejfájás gyakran társul krónikus hátfájdalommal [22], fi bromyalgiával [23], arcfájdalommal [24] és temporomandibularis zavarokkal [25], illetve a krónikus fejfájás és a musculoskeletalis fájdalom közötti bizonyított, kétirá-nyú kapcsolat azt sugallják, hogy a fejfájás és a fájdalom krónikussá válásában az egész központi fájdalomérzékelő rendszer szerepet játszik [10].…”

Section: Klinikai Megjelenésunclassified

Fájdalomcsillapító-túlhasználathoz társuló fejfájás

et al. 2015

View full text Add to dashboard Cite

A fájdalomcsillapító-túlhasználathoz társuló fejfájás a lakosság 1-2%-át érinti. Bármely fájdalomcsillapító rendszeres, havonta legalább 10 napon történő szedése kiválthatja, ezért minden olyan esetben gondolni kell rá, amikor koráb-ban is panaszos betegek fejfájásának gyakorisága -nagyobb mennyiségben szedett fájdalomcsillapítók mellett -megnő. A kórkép leggyakrabban a 40-50 éves nőket érinti: kockázatát növeli a dohányzás, az elhízás, a depresszió, valamint a szorongásos zavar. Kialakulásában biológiai (genetikai megalapozottság, neurokémiai és neurofi ziológiai eltérések) mellett pszichológiai, illetve életvezetési tényezők, így a fejfájásokra vonatkozó anticipátoros szorongás, a fájdalom katasztrofi zálása, az ezek miatti kényszeres gyógyszerszedő magatartás is fontos szerepet játszanak. A fáj-dalomcsillapító-túlhasználathoz társuló fejfájás kezelésének elengedhetetlen része a kiváltó szer megvonása, a megvonási tünetek (köztük a rebound fejfájás) kezelése, a hatásos preventív terápia bevezetése, a komorbid betegségek kezelése, valamint a betegek megfelelő oktatása és pszichés támogatása. Mivel a visszaesés esélye megfelelő kezelés mellett is 30-40% lehet, alapvető fontosságú a megelőzés, amelyben az alapellátás szerepét nem lehet eléggé hangsúlyozni. Orv. Hetil., 2015, 156(30), 1195-1202. Kulcsszavak: fejfájás, fájdalomcsillapító-túlhasználat Medication-overuse headacheMedication-overuse headache affects 1 to 2 percent of the population. Any kind of painkiller, if taken regularly at least 10 days per month can cause medication-overuse headache, and therefore the possibility of this headache has to be raised whenever a patient with a preexistent headache notices a signifi cant increase in headache frequency during a period of frequent painkiller consumption. Medication-overuse headache is most prevalent in females between 40 and 50 years of age. Its main risk factors are smokig, obesity, depression, and anxiety. The pathomechanism of medication-overuse headache is complex, with a probable genetic propensity and other biological (neurochemical and neurophysiological), as well as psychological and behavioural factors (such as anticipatory anxiety, catastrophisation of pain and consequentially a compulsive painkiller use) contributing to its genesis. The prerequisite of successful treatment is the withdrawal of the overused substance, other necessary elements of the therapy include the treatment of withdrawal symptoms including rebound headache, the introduction of an effective preventative therapy, taking into consideration the highly prevalent comorbid disorders as well, and the education and psychological support of patients. As the relapse rate can be as high as 30 to 40% regardless of effective treatment, the prevention of medication-overuse headache is of paramount importance, and the role of general practitioners can hardly be overstated.

show abstract

“…This could lead to a ''rebound'' phenomenon in which the use of abortive agents paradoxically increases the frequency and severity of head pain. Numerous studies have noted the need to eliminate these agents from the patient's treatment as ongoing ''overuse'' negatively impacts both pharmacological and non-pharmacological interventions [30,31].…”

Section: Behavioral Assessmentmentioning

confidence: 99%

Application of behavioral therapies in adult and adolescent patients with chronic migraine

Weeks

2013

Neurol Sci

View full text Add to dashboard Cite

Patients with chronic migraine (CM) headaches present some of the most difficult treatment challenges for headache practitioners. Attention to psychological and behavioral issues become significant treatment considerations as the frequency of a patient's headaches increases, there is increased disability secondary to headaches, and/or there is inadequate response to usually effective treatment. Recent research has identified a variety of risk factors (including medication overuse) that appear to be associated with the escalation of the frequency and severity of migraine headache and are amenable to behavioral (nonpharmacological) treatment. The present article will highlight therapies that may be effective in the treatment of patients with CM headache.

show abstract

Drug Induced Refractory Headache ‐ Clinical Features and Management

Cited by 258 publications

References 1 publication

Cefaléia crônica diária primária: a propósito de 52 casos

Cefaléia crônica diária primária: a propósito de 52 casos

Fájdalomcsillapító-túlhasználathoz társuló fejfájás

Application of behavioral therapies in adult and adolescent patients with chronic migraine

Contact Info

Product

Resources

About