药物适应性头痛（药物过量性头痛） - 偏头痛社区

<hr/> <iframe frameborder="0" src="https://v.qq.com/txp/iframe/player.html?vid=z3507q68rbf" allowfullscreen="true" width="360" height="230" scrolling="yes" align=" "></iframe> <hr/> <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 药物适应性头痛，也称为药物过度使用性头痛或反弹性头痛，是一种在治疗偏头痛、头痛、（或者其他疼痛疾病）的过程中由于频繁使用某些药物而发生的继发性头痛疾病。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 仔细观察症状、正确区分药物适应性头痛与偏头痛非常重要。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 药物适应性头痛的诊断标准是，每月必须出现<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";">14天以上、且连续三个月以上发生。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 它们几乎每天都会发作，通常是在每天醒来时开始。基本上只要止痛药的药效一消失，头痛就会再次发生。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 药物适应性头痛通常不会有畏光、畏声等偏头痛的典型症状。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 患者使用非处方止痛药（如对乙酰氨基酚或非甾体抗炎药）每月超过<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";">14天时，药物适应性头痛的风险就会大幅增加。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 其他一些（治疗偏头痛）常用药物如果每月超过9次，也会使患者面临药物适应性头痛风险。如：曲普坦、麦角胺、阿片类药物和组合镇痛药（如对乙酰氨基酚布达比酮和咖啡因）（EVE就是组合镇痛药哦！） <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 药物适应性头痛是一种治疗与症状互为因果的恶性循环：我们不得不服用越来越多的止痛药来缓解日益严重的偏头痛或头痛，药物不断增量又会诱发更多的偏头痛（或头痛）。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 药物适应性头痛会增加从发作性偏头痛转变为慢性偏头痛的风险。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 大约<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";">50%的慢性头痛患者同时也有药物适应性头痛。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> （治疗药物适应性头痛）应先咨询临床医生排除掉头痛的其他原因，并制定合适的治疗方案。方案一般会要求停止继续使用药物，这将会导致一段时间的复发性头痛。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 如果是止痛药和曲普坦类药物过量，通常会要求立即停止服用。但对于阿片类药物和巴比妥类药物，只能逐渐的减少用量。在这个停止使用药物的阶段，头痛将会变得更加严重。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 阿片类药物和巴比妥类药物的戒断症状可能包括恶心、呕吐、失眠、激动和躁动，并可能持续数周。为了减轻因为停止用产生的疼痛和不适，可以在停药阶段采取以下方法如：泼尼松龙、星状神经阻滞、和医用大麻等。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 对于情况特别严重，可能需要住院治疗，以便在医务人员的护理下逐渐减少药物。使用静脉通过注射药物和其他辅助医疗措施等，有助于缓解戒断症状。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 一项研究发现，在接受药物适应性头痛治疗的人中，有<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";">72%的患者在1-6个月内，头痛发作至少减少了<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";">50%。通过采用注射A型肉毒杆菌，神经调节仪器、<span style="font-size: 18px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; line-height: normal; font-family: "Helvetica Neue";">cgrp拮抗剂、和一些其他新疗法来预防（偏头痛），以减少对急性治疗（偏头痛）的需求，起到了很好的效果，可以降低患者面临药物适应性头痛的风险。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 偏头痛日记可以有效记录、控制药物使用情况，对那些可能正在产生药物适应性头痛的患者非常有用。 <p style="margin-top: 0px; margin-bottom: 0px; font-variant-numeric: normal; font-variant-east-asian: normal; font-variant-alternates: normal; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-stretch: normal; font-size: 14px; line-height: normal; font-family: "PingFang SC"; white-space: normal; text-indent: 2em; text-align: left;"> 在你还没有面临用药过量的风险时，采用我们偏头痛社区提出的“三药轮换法”吧！它可以帮助你延迟或避免产生药物适应性头痛。