药物过度使用性头痛的临床特点及诱发因素分析

发布时间：2018-04-30 23:41

本文选题：药物过度实用性头痛 + 横断面研究　；参考：《重庆医科大学》2014年硕士论文

【摘要】：目的：明确头痛门诊药物过度使用性头痛的临床特点、药物使用情况及诱发因素，并分析其对生活影响。方法：采用自制头痛问卷，对2010年12月到2013年9月就诊于重庆医科大学附属第一医院神经内科门诊以头痛为主诉的患者进行面对面访问。结果：共1702例以头痛为主诉患者完成问卷调查。在完成问卷调查患者中，7.3%（124/1702）的患者为药物过度使用性头痛（Medicationoveruse headache, MOH），占慢性每日头痛36.8%（124/337）。对于药物过度使用性头痛的患者，其平均年龄为50.61±10.21岁，40—50岁为患病高峰，女性和低教育水平患者比较常见。最常见原发性头痛为偏头痛（n=87,70.3%），其次为紧张性头痛（n=27,21.8%），丛集性头痛或其它类型头痛较少见。以偏头痛为原发性头痛的MOH患者其头痛首发年龄早于以紧张性头痛为原发性头痛的患者（33.78±11.29VS.27.07±13.73年， P=0.023）。最常见过度使用药物为复合止痛药（n=100,70.2%），其次是单纯止痛药（n=21,16.9%），没有患者过度使用曲普坦、麦角胺或阿片类药物。和单纯止痛药所致MOH患者相比，，复合止痛药过度使用患者MOH起病早（41.75±10.40VS.47.07±8.53年，P=0.006），从起病到MOH形成所需时间短（17.41±13.085VS.11.53±12.45年，P=0.035），MOH病程更长（6.01±6.06VS.2.38±2.56年，P=0.01），更易表现为中重度头痛（90%VS.16.7%, P=0.011）或伴随症状如恶心呕吐（63%VS.38.1%, P=0.032）、畏光（58%VS.19.2%，P=0.001）。对于头痛诱因，最常见头痛诱发因素是天气变化（59.6%）和情绪变化（58.8%）；其次是睡眠障碍（42.7%）、光线（37.95%）及头部受凉（20.2%）；大多数患者（79.3%）头痛诱因大于等于2个。结论：药物过度使用性头痛是门诊常见头痛类型，最常见过度使用药物是复合止痛药。复合止痛药较单纯止痛药致药物过度使用性头痛形成所需时间段，起病早，程度更重，伴随症状如恶心呕吐、畏光更常见。在中国，对药物过度使用性头痛认识较少，因此需要加强对患者和医护工作者教育。
[Abstract]:Objective: to identify the clinical characteristics, drug use and inducing factors of overuse headache in headache outpatient clinic, and analyze its influence on life. Methods: a self-made headache questionnaire was used to interview the patients with headache in the Department of Neurology of the first affiliated Hospital of Chongqing Medical University from December 2010 to September 2013. Results: a total of 1702 patients with headache as the main complaint completed the questionnaire. Among the patients who completed the questionnaire, 7.3R / 124R / 1702were patients with drug overuse headache, which accounted for 36.8% 12.4% 337g of chronic headache daily. The average age of patients with drug overuse headache was 50.61 卤10.21 years old or 40 to 50 years old, and it was more common in women and low education patients. The most common primary headache was migraine, the second was tension headache, the second was tension headache. Cluster headache or other types of headache were rare. The onset age of MOH with migraine as primary headache was 33.78 卤11.29VS.27.07 卤13.73 years earlier than that with tension headache. The most common overdose was the compound analgesic, ntir 100, 70.2g, followed by the simple analgesics, the analgesics 21C 16.9, and no patients overused with triptan, ergodamine or opioids, and no patients were overused with triptan, ergoglumide or opioids. Compared with patients with MOH caused by painkillers alone, The time from onset to MOH formation was 17.41 卤13.085VS.11.53 卤12.45 years. The course of MOH was longer than 6.01 卤6.06VS.2.38 卤2.56 years. It was more easily manifested as 90VS.16.71,0.011) or accompanied by symptoms such as nausea and vomiting 63VS.38.1T, P0.032, photophobia 58VS.19.2a P0.001. For headache inducement, the most common one is weather change (59.6) and mood change (58.8%), followed by sleep disorder (42.7%, light 37.95%) and head cooling (20.2T); most patients (79.3%) have more than 2 headache inducements. Conclusion: drug overuse headache is a common headache type in outpatient clinic, and compound analgesic is the most common overuse drug. Compound analgesics are more common with symptoms such as nausea and vomiting and photophobia in the time period required for the formation of overused headache caused by painkillers alone. In China, there is little understanding of drug overuse headache, so it is necessary to strengthen the education of patients and health care workers.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R741

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