Ból głowy z nadużywania leków
Streszczenie
Ból głowy z nadużywania leków (MOH, medication overuse headache) jest schorzeniem, które w znacznym stopniu upośledza codzienną aktywność. Warunkiem rozpoznania jest współistnienie przewlekłego bólu głowy u osoby predysponowanej z nadużywaniem doraźnych leków przeciwbólowych, zazwyczaj z powodu samoistnego bólu głowy. Nadużywane leki prowadzące do MOH to najczęściej środki przeciwbólowe (proste i złożone), tryptany, pochodne ergotaminy i opioidy. Mimo że szczegółowe mechanizmy nie są znane, to wiadomo, że patofizjologia MOH ma związek z dysfunkcją układów nagrody i nocyceptywnego powodującą, że nadużycie środków przeciwbólowych odwracalnie obniża próg bólu. Ze względu na niewielką liczbę wiarygodnych badań klinicznych podstawą zaleceń terapeutycznych w MOH są przede wszystkim opinie ekspertów. Kluczowe w leczeniu wydaje się poinformowanie chorego o istocie schorzenia, odstawienie nadużywanego leku (nagłe lub stopniowe) oraz wdrożenie leczenia profilaktycznego, uwzględniającego rodzaj samoistnego bólu głowy, który spowodował nadużycie leków doraźnych. W przypadku wystąpienia objawów z odstawienia, w tym nasilenia bólu głowy, można rozważyć krótkotrwałą kortykosteroidoterapię. Wydaje się, że dla skuteczności terapii nie ma znaczenia, czy odstawianie leku przeciwbólowego prowadzi się w warunkach szpitalnych czy ambulatoryjnych oraz czy prowadzi je lekarz rodzinny czy neurolog. Sugeruje się jednak, aby na czas detoksykacji hospitalizować chorych nadużywających leków działających ośrodkowo i u których spodziewane są nasilone objawy z odstawienia. Podkreśla się potrzebę zakrojonych na szeroka skalę badań farmakoklinicznych, które pozwoliłyby ustalić najkorzystniejszy algorytm postępowanie w tej grupie chorych
Słowa kluczowe: ból głowy z nadużywania lekówprzewlekły ból głowyleczeniepatofizjologia
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