الصداع الناجم عن الإفراط في استخدام الدواء (الإفراط في التريبتان أو المسكنات): ماذا تفعل عندما لا تُعيد الإرشادات وحدها النمط الانتيابي

References

DOI: 10.1111/ene.14268

• Advice alone is an appropriate initial treatment approach in patients who overuse triptans or simple analgesics and who do not have major psychiatric comorbidity.
• Drug intake can be abruptly terminated or restricted in patients overusing simple analgesics, ergots or triptan medication.
• Topiramate, onabotulinum toxin A or a monoclonal antibody targeting CGRP or the CGRP receptor are effective in patients with chronic migraine and medication overuse.
• Topiramate should not be used in women of childbearing potential.
• In clinical practice, advice to stop overuse should be provided before starting patients on these treatments (see also PICO question 5).
• Other preventive medications such as beta-blockers, flunarizine or amitriptyline may be used, although their efficacy has not been shown in randomized, placebo-controlled trials.
• Monthly migraine days were reduced by 6.6 days after 12 weeks in 667 patients with chronic migraine, 41% of whom had medication overuse.