Medication Overuse Headache

Munksgaard, Signe Bruun; Jensen, Rigmor

doi:10.1111/head.12408

Cited by 57 publications

(42 citation statements)

References 89 publications

(123 reference statements)

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“…However, epidemiological and clinical evidence suggests that the association between chronic headache and psychiatric disorders is bidirectional. Psychiatric disorders are found to be significant risk factors for development of MOH [16], and coexisting psychiatric disorders predict a worse outcome of MOH treatment [17, 18]. This bidirectional association implies that both MOH and anxiety are the result of chronic analgesic exposure.…”

Section: Discussionmentioning

confidence: 99%

Neural hyperactivity in the amygdala induced by chronic treatment of rats with analgesics may elucidate the mechanisms underlying psychiatric comorbidities associated with medication-overuse headache

2017

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BackgroundPatients with medication-overuse headache suffer not only from chronic headache, but often from psychiatric comorbidities, such as anxiety and depression. The mechanisms underlying these comorbidities are unclear, but the amygdala is likely to be involved in their pathogenesis. To investigate the mechanisms underlying the comorbidities we used elevated plus maze and open field tests to assess anxiety-like behavior in rats chronically treated with analgesics. We measured the electrical properties of neurons in the amygdala, and examined the cortical spreading depression (CSD)-evoked expression of Fos in the trigeminal nucleus caudalis (TNC) and amygdala of rats chronically treated with analgesics. CSD, an analog of aura, evokes Fos expression in the TNC of rodents suggesting trigeminal nociception, considered to be a model of migraine.ResultsIncreased anxiety-like behavior was seen both in elevated plus maze and open field tests in a model of medication overuse produced in male rats by chronic treatment with aspirin or acetaminophen. The time spent in the open arms of the maze by aspirin- or acetaminophen-treated rats (53 ± 36.1 and 37 ± 29.5 s, respectively) was significantly shorter than that spent by saline-treated vehicle control rats (138 ± 22.6 s, P < 0.001). Chronic treatment with the analgesics increased the excitability of neurons in the central nucleus of the amygdala as indicated by their more negative threshold for action potential generation (–54.6 ± 5.01 mV for aspirin-treated, –55.2 ± 0.97 mV for acetaminophen-treated, and –31.50 ± 5.34 mV for saline-treated rats, P < 0.001). Chronic treatment with analgesics increased the CSD-evoked expression of Fos in the TNC and amygdala [18 ± 10.2 Fos-immunoreactive (IR) neurons per slide in the amygdala of rats treated with aspirin, 11 ± 5.4 IR neurons per slide in rats treated with acetaminophen, and 4 ± 3.7 IR neurons per slide in saline-treated control rats, P < 0.001].ConclusionsChronic treatment with analgesics can increase the excitability of neurons in the amygdala, which could underlie the anxiety seen in patients with medication-overuse headache.Electronic supplementary materialThe online version of this article (doi:10.1186/s12868-016-0326-z) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Neural hyperactivity in the amygdala induced by chronic treatment of rats with analgesics may elucidate the mechanisms underlying psychiatric comorbidities associated with medication-overuse headache

2017

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“…Currently, there is a global trend in chronification of migraine and a growing number of cases of medication overuse headache due to improper use and/or overuse of painkillers23. Interestingly, medication overuse headache could develop not only due to overuse of opioids but even after ‘specific’ anti-migraine treatments with triptans4. Intractable forms of migraine resistant to specific anti-migraine treatments and ‘epidemics of medication overuse headache’ are raising an issue of more complex approaches on headache cure, including nutritional approach.…”

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confidence: 99%

Low serum 25-hydroxyvitamin D is associated with higher risk of frequent headache in middle-aged and older men

Virtanen

Giniatullin

Mäntyselkä

et al. 2017

Sci Rep

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Vitamin D has been suggested to have a role in various neurovascular diseases, but the data regarding headache is inconclusive. Our aim was to investigate the associations between serum 25-hydroxyvitamin D [25(OH)D], a marker for vitamin D status, and risk of frequent headache. The study population consisted of 2601 men from the population-based Kuopio Ischaemic Heart Disease Risk Factor Study (KIHD) from eastern Finland, aged 42–60 years in 1984–1989. The cross-sectional associations with prevalence of self-reported frequent headache (defined as weekly or daily headaches) were estimated with multivariable-adjusted odds ratios. The average serum 25(OH) concentration was 43.4 nmol/L (SD 18.9, min-max 7.8–136.1 nmol/L). A total of 250 men (9.6%) reported frequent headache. The average serum 25(OH)D concentration among those with frequent headache was 38.3 nmol/L (SD 18.8) and 43.9 nmol/L (SD 18.9) among those without frequent headache, after adjustment for age and year and month of blood draw (P for difference <0.001). After multivariable adjustments, those in the lowest vs. the highest serum 25(OH)D quartile had 113% (95% CI 42, 218%; P for trend <0.001) higher odds for frequent headache. In conclusion, low serum 25(OH)D concentration was associated with markedly higher risk of frequent headache in men.

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“…A topiramát hatékonyságát nyílt vizsgálatok után placebokontrollált vizsgálatok is igazolták krónikus migrénhez társuló gyógyszer-túlfogyasztás esetén [57,58]. Több nyílt klinikai vizsgálat igazolta a valproát, illetve [59]. Az onabotulinumtoxin-A hatékonyságát a krónikus migrénes betegek kö-rében végzett PREEMPT vizsgálat utólagos elemzése bizonyította, amelynek során a kezelés előtt a fájdalom-csillapítók túlzott használatához társuló fejfájás kritériu-mait teljesítő betegek adatait külön elemezték [60].…”

Section: Profi Laktikus Terápiaunclassified

“…A lakosság körében végzett széles körű felvilágosítással az FTTF-esetek előfordulási gyakorisága csökkenthető lenne [59]. Az orvosi gyakorlatban az FTTF lehetőségét fel kell vetni minden olyan beteg esetén, aki mindennapos vagy csaknem mindennapos gyakoriságú fejfájást panaszol.…”

Section: Prevencióunclassified

Fájdalomcsillapító-túlhasználathoz társuló fejfájás

et al. 2015

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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.

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Medication Overuse Headache

Cited by 57 publications

References 89 publications

Neural hyperactivity in the amygdala induced by chronic treatment of rats with analgesics may elucidate the mechanisms underlying psychiatric comorbidities associated with medication-overuse headache

Neural hyperactivity in the amygdala induced by chronic treatment of rats with analgesics may elucidate the mechanisms underlying psychiatric comorbidities associated with medication-overuse headache

Low serum 25-hydroxyvitamin D is associated with higher risk of frequent headache in middle-aged and older men

Fájdalomcsillapító-túlhasználathoz társuló fejfájás

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