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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2018; 76(10): 668-673
DOI: 10.1590/0004-282X20180097
Article

Medication-overuse headache. Retrospective comparison of preventive treatments

Cefaleia por uso excessivo de medicamentos. Comparação retrospectiva de tratamentos preventivos
Abouch V. Krymchantowski
1   Centro de Avaliação de Tratamento da Dor de Cabeça do Rio de Janeiro, Rio de Janeiro RJ, Brasil
,
Ana Gabriela Ferreira Krymchantowski
1   Centro de Avaliação de Tratamento da Dor de Cabeça do Rio de Janeiro, Rio de Janeiro RJ, Brasil
,
Carla da Cunha Jevoux
1   Centro de Avaliação de Tratamento da Dor de Cabeça do Rio de Janeiro, Rio de Janeiro RJ, Brasil
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ABSTRACT

Objectives: Medication-overuse headache is commonly seen in tertiary centers. Limited evidence is available regarding treatment. We compared the use of one or two drugs, three drugs, or four pharmacological agents for the prevention of headache.

Methods: This was a retrospective analysis of 149 consecutive patients. Sudden withdrawal and pharmacological prevention with one or more drugs were carried out. Adherence and the decrease of headache frequency of more than 50% were compared after four months between the one or two, three, and four drug groups.

Results: There was no difference in adherence (p > 0.6). Headache frequency reduction was shown in 23 (54.8%, one or two drugs), 33 (70%, three drugs) and 11 (55%, four drugs); p = 0.13 and p = 0.98, not significant. There was a tendency towards significance between the one or two drug takers versus the three drug and four drug takers together (p = 0.09).

Conclusions: The use of more drugs was not better at improving headache. However, there is the possibility that acting simultaneously on different sites may promote broader modulation and better outcome.

RESUMO

Objetivos: Cefaleia por uso excessivo de medicamentos (CEM) é comum em centros terciários. Existe evidência limitada quanto a estratégias de tratamento e se combinar drogas é melhor do que abordagens com monoterapia. Objetivamos comparar o uso de até dois, três ou quatro agentes farmacológicos para a prevenção.

Métodos: Estudo retrospectivo de 149 pacientes consecutivos. A suspensão súbita das drogas usadas em excesso e o início de prevenção foram realizados. A adesão e a redução superior a 50% na frequência da cefaleia foram comparadas após quatro meses entre até duas drogas, três drogas e quatro drogas.

Resultados: A adesão não foi diferente (p > 0.6). A redução da frequência de cefaleia foi de 23 (54.8%, até duas drogas, 33 (70%, três drogas) e 11 (55%, quatro drogas; p = 0.13 e p = 0.98, não significativo). Houve uma tendência à significância quando comparamos até duas drogas com três e quatro drogas (p = 0.09).

Conclusões: Não demonstramos superioridade de mais drogas, comparando-se a um ou dois medicamentos. Acreditamos na possibilidade de atuação em sítios de diferentes de forma simultânea e a modulação mais abrangente com melhores parâmetros evolutivos.

Keywords:

Medication-overuse - headache - migraine - treatment

Palavras-chave:

Cefaleia por uso excessivo de medicamentos - enxaqueca - migrânea - tratamento


Publication History

Received: 06 May 2018

Accepted: 20 June 2018

Article published online:
22 August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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