著者
五十嵐 久佳
出版者
日本神経治療学会
雑誌
神経治療学 (ISSN:09168443)
巻号頁・発行日
vol.36, no.3, pp.229-232, 2019 (Released:2019-11-25)
参考文献数
24

Both of chronic migraine (CM) and medication–overuse headache (MOH) are common neurological diseases. They have a great detrimental influence on a patient's life, with a severe impact on socioeconomic functioning and quality of life.One of the most common causes of migraine chronification is acute medication overuse. On the other hand, MOH is an interaction between a therapeutic agent used excessively and a susceptible patient. Among those with a previous primary headache diagnosis, about 80% of MOH patients have migraine.All patients with CM should be considered for pharmacological prophylaxis, and the behavioral aspects of therapy should be emphasized. The two prophylactic drugs with the best evidence for efficacy in CM are topiramate and onabotulinumtoxinA. But these therapies currently have not been covered by health insurance in Japan. The options to treat patients with CM are valproic acid, propranolol, lomerizine and amitriptyline. The treatment principles for MOH are : (1) discontinue the overused medication, (2) treat the headache after discontinuing the overused medication, and (3) administer prophylactic medications. Clinical evidence shows that the majority of patients with MOH improve after discontinuation of the overused medication, as does their responsiveness to preventative treatment. Simple advice on the causes and consequences of MOH is an essential part of its management and can be provided with success. Initiation of prophylactic medications at the time of withdrawal or even before withdrawal of overused medications is recommended. Since most of the MOH patients have migraine prior to MOH, valproic acid, lomerizine, propranolol, amitriptyline may be considered as prophylactic medications. As for prognosis, the relapse rate is approximately 30%. Even after discontinuation, patients should be given suitable counseling, and headache diary should be used to confirm the frequency of using triptans, ergotamine and analgesics.

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23/100 『慢性片頭痛と薬物乱用頭痛(MOH)』 ✅慢性片頭痛 ・15日/月↑頭痛 ・3ヶ月↑持続 ・8日/月↑片頭痛 ✅MOH ・15日/月↑頭痛 ・3ヶ月↑服薬 → 15日/月↑非オピオイド系 → 10日/月↑他薬剤 ✅MOH治療 ・原因薬物中止 ・中止後の対処 ・予防薬投与 https://t.co/3DP8vJYCii https://t.co/smyLchOg90
【2019/11/27市販薬情報】鎮痛薬が原因で起きる”薬物乱用頭痛”をご存知ですか? ”市販薬の安易な頻回使用を避けるための一般市民を対象とした啓発活動も重要である” 11/25公開:慢性片頭痛・薬剤の使用過多による頭痛(薬物乱用頭痛)の治療/神経治療学/36 巻 (2019) 3 号https://t.co/2uBZiwQ7b1

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