Abusotic headache

Abuzusnaya headache, or so-called "ricochet", a drug headache is one of the secondary forms of cephalgia, closely related to migraine. In recent years, it has become increasingly important in our country. This is due to the wide spread and availability of a variety of pain medications.

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Epidemiology of Abyssus Headache

Abusus, or abuse, depends on how many days a month a patient takes a medication. Important factors - the frequency and regularity of taking the drug / drugs. So, if the use of the drug at least 10 days per month is mentioned in diagnostic criteria, it means 2-3 days of treatment per week.

Abuzusnaya headache is the third most frequent after migraine, its prevalence among patients of specialized centers of cephalalgia reaches 10%, and in the population - 1%.

Abbusum headache is manifested by bilateral cephalgia of a pressing or compressive nature, of minor or moderate intensity. Painful sensations when the patient is abused by pain medication (at least 15 days per month for 3 months or more) is concerned for 15 days or more, up to the daily.

What causes an abusus headache?

Abbusic headache is most often caused by such drugs as: analgesics and NSAIDs, combined analgesics, ergotamine derivatives, serotonin agonists, tryptans, opioids. In the study of the anamnesis of patients with abusic headache, it was found that some time ago patients had typical forms of primary cephalgia: 70% - episodic migraine attacks.

The piercing of abusic headache is a drug abusus, the main risk factor is the regular use of pain medications. The alternation of periods of frequent use of the drug with relatively long periods without treatment is much less likely to result in the formation of an abusic headache. Medicinal abuzus - the main factor in the transformation of episodic cephalgia into chronic. The mechanism of this paradoxical effect of anesthetic drugs has not yet been studied. The basis of the abusus headache is the presence of migraine. Interestingly, chronic abuse of analgesics for reasons not related to pain in the head (for example, about arthritis) does not cause an abusus headache.

Along with the abuse of drugs to the pathogenetic factors of a condition such as an abusus headache include affective disorders - depression and anxiety that promote the development of psychological dependence on medicines. It was shown that depressive disorders cause the propensity of patients to abuse drugs: it is noted in 48% of persons with depression (against 38.6% in patients without depression). In many patients with abusus headache there is a hereditary predisposition to alcoholism, depression, drug abusus.

Symptoms of Abussus Headache

As already mentioned, Abuzus occurs in patients who have suffered from primary forms of cephalgia for a long time. Therefore, at an early stage, the abusic headache manifests itself in a more or less typical pattern of episodic migraine, which eventually transforms into a chronic one as the abusus factor increases (increasing the frequency of taking drugs and / or their dose). In the expanded stage, the abusus headache occurs daily, as a rule, persists throughout the day, varying in intensity. It is present already at the moment of awakening, the patients describe it as weak, moderate, dull, bilateral, frontal-occipital or diffuse. Significant increase in pain can occur at the slightest physical or intellectual load, as well as in cases when the intake of drugs is interrupted. Painkillers cause transient and usually incomplete relief of cephalgia, which forces patients to take medicine again and again. In addition, the cephalgia, combined with the abusus, can very sharply, sometimes within one day, change its characteristics.

Abusus is shown to be the most common cause of migraine headaches up to 15 days per month and more, as well as the development of mixed cephalgia, characterized both by migraine features and clinical signs of cephalgia, also occurring with a frequency of more than 15 days per month. 

Abussural headache: classification

Cefalgia with excessive use of drugs constitute one of the subsections of ICHB-2. In addition to the abusus headache, this section includes the following subsections: "8.1. Cefalgia caused by acute or prolonged exposure to substances "; "8.3. GTSefalgiya as a side effect of long-term use of drugs "; "8.4. Cephalgia associated with cancellation of drugs. "

• 8.2. Abuzusnaya headache.
  • 8.2.1. With excessive use of ergotamine.
  • 8.2.2. With excessive use of triptans.
  • 8.2.3. With excessive use of analgesics.
  • 8.2.4. With excessive use of opiates.
  • 8.2.5. With excessive use of combined drugs.
  • 8.2.6. Caused by the excessive use of other drugs.
  • 8.2.7. Possibly caused by excessive use of drugs.

Among all types of abusic headache, the greatest clinical value in the world is cefalgia associated with the abuse of analgesics or combination drugs (ie, combinations of analgesics with other medicines: codeine, caffeine, etc.). It is assumed that any component of combined drugs can cause an abusic headache, but the greatest "share of responsibility" (up to 75%) lies on analgesics. At the same time, this type of abusic headache is characterized by considerable therapeutic resistance.

How is the Abusus Headache recognized?

One of the main questions facing the doctor, if he suspected a drug abusus in a patient with cephalalgia, is the question of the degree of probability of the diagnosis (a definite or only possible link exists between cephalgia and the effect of the substance). In many cases, the diagnosis of "abusus headache" becomes evident only after the pain syndrome decreases after the cessation of exposure to this substance. If cephalgia does not stop or is not significantly relieved within 2 months after the "guilty" medication has been stopped, the diagnosis of "abusus headache" can be considered questionable. In this case, you need to look for other causes of chronic cephalalgia (primarily emotional disorders).

8.2.3. Cefalgia with excessive use of analgesics

• A. Cephalgia present for more than 15 days per month meeting criteria C and D and having at least one of the following characteristics:
  • bilateral;
  • Pressing / compressive (non-pulsating) character;
  • insignificant or moderate intensity.
• B. Taking simple analgesics for at least 15 days a month for 3 months or more.
• C. Cephalgia developed or worsened significantly during excessive intake of analgesics.
• D. Cephalgia stops or returns to the previous pattern within 2 months after discontinuation of taking analgesics.

It should be emphasized that patients with primary cephalalgia, who develop a new type of cephalgia, or those with migraine significantly heavier against the background of the drug abusus, should establish not only the diagnosis of the original primary cephalgia, but also the diagnosis of "abusic headache". An example of a diagnosis: "Cephalgia with pericranial muscle tension. Abuzusnaya headache ». Many patients who meet the criteria for a possible abusic headache also meet the criteria for possible chronic migraine. Before establishing the actual cause after absozusnogo abolition of these patients should be set both diagnoses.

For the diagnosis of abusus headache, no additional studies are needed. The most informative method that confirms the presence of a drug abusus is the patient's diary of cephalgia, in which he notes the time of onset of attacks of cephalalgia and the number of pain medications taken.

Abuse headache treatment

Treatment of abusus headache includes explanation to the patient of the mechanism of pain formation, gradual complete abolition of the "guilty" drug, alleviation of withdrawal symptoms and specific therapy of residual cephalgia. To prevent abusus, the doctor should explain to patients (especially with frequent attacks of cephalalgia) the danger of abuse of analgesics. The medicinal abuzus significantly complicates the treatment of patients with chronic migraine forms. Therefore, the most important condition that ensures the effectiveness of preventive therapy for migraines is the abolition of the drug that caused the abusus. When identifying a drug abusus, you need to convince the patient to reduce the dose of pain medication, right up to the total withdrawal from analgesics. Complete withdrawal of drugs (provided that this is a non-narcotic analgesic) is the only effective treatment. In severe cases, patients are detoxified in a hospital. It is shown that the number of days with an abusum headache per month is reduced by 50% 14 days after the abolition of the "guilty" drug. In case of successful treatment, cephalic transformation is transformed into the original form.

In parallel with the cancellation of the "guilty" drug, a traditional migraine therapy should be prescribed to the patient.

One of the most effective approaches to the treatment of abusus headache is the appointment of antidepressant therapy. Despite known side effects, one of the most effective drugs remains tricyclic antidepressant amitriptyline. Positive effect in the appointment of amitriptyline is noted in 72% of patients, in contrast to 43% with the discontinuation of taking analgesics without concomitant antidepressant therapy. In some patients, antidepressants from the group of selective serotonin reuptake inhibitors (paroxetine, sertraline, fluoxetine) and selective serotonin and norepinephrine reuptake inhibitors (duloxetine, venlafaxine, milnacipran) have a good effect. If the abusic headache is combined with chronic migraine, the drugs of choice are anticonvulsants (for example, topiramate).

Due to the high incidence of relapse (more than 30%) after abusus removal, it is important to warn the patient about the likelihood that an abusus headache may return and explain to him the need to strictly control the amount of pain medication.

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