Evaluation Of The Therapeutic Efficiency On Medication Overuse Headache

Objective On the basis of programmed therapy of medication overuse headache(MOH),the value and efficacy of individualized treatment are evaluated.Method MOH patients were screened according to the diagnostic criteria of the 2013 headache classification committee of international headache association(ICHD)-3 beta.The procedure of education,drug withdrawal and preventive treatment were adopted,which was used internationally,and these patients were also treated with individualized therapeutic regimen according to their emotional state and reaction to the drug before.The treatment of MOH patients was followed up for 1 year.All patients were asked to write the headache diary.Visual Analogue Scale(VAS)was used to assess headache intensity in MOH patients.The headache frequency,headache intensity,the number of days of acute pain per month,the days of taking analgesics permonth were recorded before treatment and during follow-up period.The therapeutic responses and changes of the illness were recorded at the follow-up sixth and twelfth month.Those patients with emotional disorder were treated actively,and the levels of anxiety and depression were evaluated before and during follow-up period using Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS).The efficacy and adverse side effects of headache prophylactic medication were observed.Result Totally 34 cases of patients were diagnosed with MOH,and 19 cases were enrolled in the treatment study after screening,in which 18 cases were complicated MOH patients,and 1 case was uncomplicated MOH patient.19 patients participated in this study,16 of 19 completed the 12 months follow-up study according to the requirements,17 of 19 completed 6 months follow-up study,with 3 of 19 were dropped out of this study,and the final loss rate was 15.8%.According to the basic data,57.9% of the patients was accompanied with emotional disorders.MOH patients with emotional disorderstook more analgesics everyday(bag,granule,tablet/day)compared with those with no emotional disorders,the difference was statistically significant(4.6±3.4 VS 2.3±1.0,P=0.049).The most common overused analgesics were combination analgesics(63.2%).At the follow-up 1st,3rd,6th and 12 th month,the MOH patients' headache frequencyand the number of days of taking analgesics compared with baseline,were significantly reduced,also the degree of headache was significantly reduced,the differences were statistically significant(P<0.01).The total effective rate at the 6th month is 64.7%(n = 11)and the total effective rate at the 12 th month is 68.75%(n = 11).At the 6th month the patients' anxiety and depression levels were significantly lower than that of the baseline,with statistically significant differences(P<0.05).At the 12 th month the patients' anxiety and depression levels were lower than that of the baseline too,but the difference was not statistically significant.At follow-up 6th and 12 th month there was no statistically significant difference found in the treatment efficacy between patients with emotional disorder and patients without.Most patients could tolerate the side effects of the drug,and the side effects could be improved with the reduction of the dose.The programmed therapywas ineffective for minority patients,but the traditional chinese medicine and radiofrequency hyperthermia were possibly effective.Conclusion In our province.most of the MOH patients who need to visit the hospital usually overuse the combination analgesics,they are more often accompanied by emotional disorders and to be complicated type.Compared with MOH patients without emotional disorders,patients with emotional disorders take more times of analgesics every day.Based on the structured detoxification treatment,the individualized treatment program is effective.Positive detailed assessment and treatment of MOH patients with emotional disorders can achieve the same effect as those with no emotional disorders.Therefore,the evaluation and treatment of emotional disorders play an important role in the prevention and treatment of MOH.The administration of headache prophylactic drugs is necessary to adjust the dose and type according to the patients' response and request to achieve the desired effect.The ineffective patients may try other treatment methods which may benefit them.The side effects of the administered drugs in this observation were tolerable and no severe adverse events occurred.