Clinical Study Of Medication-overuse Headache

Analysis on the risk factors of the medication-overuse in patients with chronic migraine Objective:The purpose of this study was to analysis the risk factors of medication-overuse headache (MOH) in patients with chronic migraine.Methods:157 patients who were diagnosed as chronic migraine and were chosen from headache out-patient of Shandong Provincial Hospital Affiliated to Shandong University from Jan 2013 to Dec 2015. All the subjects were followed up by the authors. Of these subjects,63 cases with MOH were compared with 94 controls without MOH. Based on a standardized questionnaire, a database was made with Microsoft Office Excel 2015. The data including 45 indexes were analyzed by univariate analysis with Chi-square test, Fisher’s exact test,t-test or paired rank test respectively. The statistically correlated variables (P<0.05) were chosen as the independent variable, then nonconditional multivariate stepwise logistic regression was made.Results:The independent risk factors of medication-overuse headache were the frequency of overused medicine, ACS scores, anxiety disorder and not standardized prevention and treatment.Conclusions:The frequency of overused medicine, ACS scores, anxiety disorder and not standardized prevention and treatment are the independent risk factors for medication overuse in patients with chronic headache.Magnetic resonance imageing of migraine patients with drug overuseBackgrounds Studies have shown that recurrent migraine can be transformed into chronic migraine, and medication overuse headache is a secondary chronic headache in the international community.MOH significantly affect the work and quality of life of patients, and even lead to serious disability, at the same time often associated with epilepsy, depression and emotional disorders and other diseases. MOH treatment is difficult, high recurrence rate. The pathophysiologic mechanism of MOH has not been fully elucidated at this time, but the prevailing view is that it is significantly associated with the slowing down of episodic migraine. Neuroimaging studies have shown that functional and structural changes in the pain-related network of migraine patients,revealing the pathophysiologic mechanism of migraine in some extent. Magnetic resonance imaging confirmed that brain structure and function will change in patients with paroxysmal migraine. Diffusion tensor imaging(DTI), as a noninvasive technique, is mainly used for the observation and tracking of white matter fiber bundles, and can clearly and intuitively reflect the brain lesions.Objective Magnetic resonance imaging (MRI) was used to compare the areas of interest in the frontal lobe, limbic system, and midbrain of patients with MOH and age-and gender-matched healthy subjects to study the changes of brain structures such as gray matter and white matter. Combined with clinical characteristics of correlation analysis..Methods 80 patients with migraine headache from Shandong Provincial Hospital were selected as MOH group from March 2014 to February 2015, and 80 healthy subjects were selected as the control group. T1, T2 and FLAIR of transversal sagittal plane and coronal plane were performed by using 3T superconducting MRI imager and spin echo sequence. SPM8 was used to analyze magnetic resonance imaging data. MRI images were analyzed and the number, (FA) and apparent diffusion coefficient (ADC) were measured by diffusion tensor imaging (DTI) in the frontal lobes, limbic system, and midbrain, respectively. The area of interest was measured by diffusion tensor imaging (DTI), The type of abnormal structure and the position of the lesion were compared. The differences of brain structure between MOH patients and healthy people were compared.Results There was no significant difference in total gray matter volume (GMV) between the two groups (P> 0.05). There was a positive correlation between GMV and body mass index (BMI) and gender factors, but there was a significant negative association with age, headache chronicity, HAMD scores. Compared with the healthy control group, the volume of gray matter in the brain regions of the MOH group was significantly lower than that in the right inferior temporal gyrus, right temporal pole, left middle cingulate gyrus, right Rolandik island cap, bilateral orbital frontal gyrus There was statistical significance (P<0.05). The results of ROI showed that there was no significant correlation between multiple brain regions including the temporal region and the total course of headache, and there was a negative correlation between headache duration and headache frequency. Compared with the healthy control group, the ADC values of the right orbital frontal cortex and the left inferior frontal cortex in the MOH group were significantly higher than those in the healthy control group (P <0.05). The FA values of the bilateral orbital frontal cortex and the right internal hind limb in the MOH group were inversely proportional to the headache frequency and the course of the disease. The FA value of the left internal capsule and the headache frequency were negatively correlated. The changes of ADC values in the orbital frontal cortex and cingulate cortex were correlated with the headache frequency and the course of disease in MOH group.Conclusion MOH patients showed more severe mood disorders, cognitive impairment, and disability compared with healthy controls. MOH is mainly associated with pain and mental-related regional gray matter loss.Gray matter gray decreased in rolandic operculum cover (rolandic operculum) of MOH patients, suggesting that the structure may be related to the pathogenesis of MOH. Bilateral frontal cortex and cingulate cortex microstructure changed in MOH patients, and closely related with the course and frequency of seizures.Efficiency of botulinum toxin A in the treatment of medication overuse headacheObjective To observe the efficacy of effects of botulinum toxin type A in the treatment of medication overuse headache.Methods 60 cases of MOH patients from neurology headache outpatient of Shandong Provincial Hospital were randomly divided into control group and treatment group. It is recommended that MOH patients discontinue various analgesics. The treatment group was treated with botulinum toxin A, according to the patient’s condition, the conventional dose was selected. The injection was performed with lml syringe in the pain distribution area and the trigger point, thirty-one injection sites were selected, each site 5U. Three months later the same method and dose repeated injection. The control group was treated with topiramate.6 months of observation. The degree of headache disability was assessed by the Migraine Disability Assessment Questionnaire (MIDAS). The health status of the patients was assessed by 36-item Short Form Health Survey (SF-36). The scores of MIDAS and SF-36 before and after treatment, the frequency of headache attacks, duration and severity of adverse events were compared between the two groups.Results Compared with the control group, patients who were treated with botulinum toxin type A had been suffered less headache attack times and shorter duration (P<0.05), with a significant difference. There was obvious improvement on headache severity and SF-36 (P<0.05), with a significant difference. There was no obvious difference between observation group and control group in adverse drug reaction occurrence rate (P>0.05), with no significant difference.Conclusion MIDAS questionnaire scores suggest that MOH has a greater impact on the patient’s learning, life and work In this study. The MDQ-H score suggested that the subjects had a drug-dependent profile. Compared with the use of topiramate alone, botulinum toxin A can effectively reduce withdrawal symptoms caused by withdrawal such as headache.Compared with oral topiramate, the use of botulinum toxin type A did not increase adverse reactions, no serious side effects.