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Secondary headache attributed to exposure to or overuse of a substance.
Cephalalgia ( IF 4.9 ) Pub Date : 2020-08-20 , DOI: 10.1177/0333102420942238
Kati Toom 1, 2 , Mark Braschinsky 1, 2 , Mark Obermann 3, 4 , Zara Katsarava 4, 5, 6, 7
Affiliation  

Background

Secondary headaches attributed to exposure to or the overuse of a substance are classified under chapter eight in the International Classification of Headache Disorders 3rd edition. Three distinct sub-chapters consider: 1. Headache attributed to exposure to a substance, 2. Medication overuse headache, and 3. Headache attributed to substance withdrawal. Headache attributed to exposure to a substance refers to a headache with onset immediately or within hours after the exposure, while medication overuse headache is a headache occurring on 15 or more days per month that has developed as a consequence of regular usage of acute headache medication(s) for more than three consecutive months in a patient with a pre-existing primary headache disorder. The withdrawal of caffeine, oestrogen, and opioids is most often associated with the development of headache.

Discussion

Despite the current headache classification, there is no certainty of a causal relationship between the use of any substance and the development of headache. Some substances are likely to provoke headache in patients that suffer from a primary headache disorder like migraine, tension-type headache or cluster headache, while others were described to cause headache even in people that generally do not get headaches. Toxic agents, such as carbon monoxide (CO) are difficult to investigate systematically, while other substances such as nitric oxide (NO) were specifically used to induce headache experimentally. If a patient with an underlying primary headache disorder develops a headache, in temporal relation to exposure to a substance, which is significantly worse than the usual headache it is considered secondary. This is even more the case if the headache phenotype is different from the usually experienced headache characteristics. Medication overuse headache is a well-described, distinct disease entity with only marginally understood pathophysiology and associated psychological factors. Managing medication overuse headache patients includes education, detoxification, prophylactic treatments and treating comorbidities, which is reflected in available guidelines. Viewing medication overuse headache as a separate entity helps clinicians and researchers better recognise, treat and study the disorder.

Conclusion

Identification of substances that may cause or trigger secondary headache is important in order to educate patients and health care professionals about potential effects of these substances and prevent unnecessary suffering, as well as deterioration in quality of life. Treatment in case of medication overuse and other chronic headache should be decisive and effective.



中文翻译:

因接触或过度使用某种物质而引起的继发性头痛。

背景

归因于接触或过度使用某种物质的继发性头痛归入《国际头痛疾病分类》第 3 版的第 8 章。三个不同的子章节考虑:1. 因接触某种物质引起的头痛,2. 药物过度使用性头痛,以及 3. 因物质戒断引起的头痛。暴露于某种物质引起的头痛是指在暴露后立即或数小时内发作的头痛,而药物过度使用性头痛是每月发生 15 天或更多天的头痛,这是由于经常使用急性头痛药物而引起的( s) 先前患有原发性头痛疾病的患者连续三个月以上。戒断咖啡因、雌激素、

讨论

尽管目前有头痛分类,但并不确定使用任何物质与头痛的发展之间存在因果关系。有些物质可能会导致患有原发性头痛疾病(如偏头痛、紧张型头痛或丛集性头痛)的患者头痛,而另一些物质则被描述为即使在通常不会头痛的人群中也会引起头痛。一氧化碳 (CO) 等有毒物质难以系统地研究,而其他物质 (如一氧化氮 (NO)) 则专门用于通过实验诱发头痛。如果患有潜在原发性头痛疾病的患者出现与接触某种物质的时间相关的头痛,这种头痛比通常的头痛严重得多,则被认为是继发性的。如果头痛表型与通常经历的头痛特征不同,则情况更是如此。药物过度使用性头痛是一种描述充分、独特的疾病实体,对病理生理学和相关的心理因素知之甚少。管理药物过度使用性头痛患者包括教育、解毒、预防性治疗和治疗合并症,这些都反映在现有指南中。将药物过度使用性头痛视为一个单独的实体有助于临床医生和研究人员更好地识别、治疗和研究这种疾病。管理药物过度使用性头痛患者包括教育、解毒、预防性治疗和治疗合并症,这些都反映在现有指南中。将药物过度使用性头痛视为一个单独的实体有助于临床医生和研究人员更好地识别、治疗和研究这种疾病。管理药物过度使用性头痛患者包括教育、解毒、预防性治疗和治疗合并症,这些都反映在现有指南中。将药物过度使用性头痛视为一个单独的实体有助于临床医生和研究人员更好地识别、治疗和研究这种疾病。

结论

识别可能导致或引发继发性头痛的物质非常重要,以便让患者和医疗保健专业人员了解这些物质的潜在影响,并防止不必要的痛苦以及生活质量下降。在药物过度使用和其他慢性头痛的情况下,治疗应该是果断和有效的。

更新日期:2020-08-21
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