Author/Editor     Zaletel, Marjan
Title     Glavobol ob prekomernem jemanju zdravil
Translated title     Medication-induced headache
Type     članek
Source     Med Razgl
Vol. and No.     Letnik 39, št. Suppl 9
Publication year     2000
Volume     str. 69-75
Language     slo
Abstract     Analgesic overuse by headache-prone patients frequently produces a syndrome of medication-induced headache. The International Headache Society's classification system for headaches also includes headache induced by chronic substance abuse. A reasonable working definition of analgesic-related headache has been proposed. The prevalence and incidence of medication-induced headache remains unknown. The important clinical features are its daily occurrence, appearance only in patients with primary headache and a drug-dependent rhythmicity of headaches. Headache may be accompanied by additional symptoms. The pathophysiology of medication-induced headache is poorly understood.The essential printiples are: discontinuation of the drug, attempts to break the cycle by administering dihydroergotamine or nonsteroidal antiinflammatory drugs, initiation of prophylactic pharmacotherapy, concomitant behavioural intervention and adequate education. Abrupt discontinuation of the precipitating analgesics is necessary, and the use of nonsteroidal antiinflamatory drugs, dihydroergotamine and prophylactic drugs improve the outcome. The long-term susess of withdrawal therapy requires a comprehensive educational and follow-up program involving pharmacological, dietary and behavioural components.
Summary     Prekomerno jemanje analgetikov pri bolnikih, ki so nagnjeni h glavobolu, povzroči sindrom glavobola zaradi zdravil. V klasifikacijskem sistemu mednarodnega združenja za glavobole je opredeljen kot glavobol zaradi kronične zlorabe zdravil. V praktične namene se lahko uporabljajo prirejena merila. Prevalenca in incidenca glavobola zaradi zdravil ni znana. Pomembne klinične značilnosti glavobola zaradi zdravil je, da je to dnevni glavobol, ki se najpogosteje pojavi pri bolnikih s primarnim glavobolom in se pojavlja predvidljivo. Glavobol lahko spremljajo dodatni znaki. Patofiziologija nastanka glavobola zaradi zdravil ni pojasnjena. Osnovna načela zdravljenja so: ukinitev analgetika, prekinitev glavobola z nesteroidnimi analgetiki in dihidroergotaminom, uvedba preventivnega zdravila, uporaba vedenjskih tehnik in izobraževanje bolnika. Nejpomembnejši ukrepi so takojšnja ukinitev analgetika, zdravljenje z nesteroidnimi analgetiki, dihidroergotaminom in uvedba prevenitvnega zdravila pa poveča učinek zdravljenja.Za dolgoročni uspeh zdravljenja glavobola zaradi zdravil je pomembno izobraževanje bolnikov in programi, ki vključujejo farmakološke, prehrambene in vedenjske ukrepe.
Descriptors     HEADACHE
ANALGESICS
DRUG THERAPY
SUBSTANCE USE DISORDERS
SUBSTANCE WITHDRAWAL SYNDROME