RU2538627C1 - Method of treating patients with medication overuse headache - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: analgesic preparation causing medication overuse headache are withdrawn; a detoxification therapy is conducted; an analgesic alternative is provided; a preventive medication and a behaviour therapy are applied. The preventive medication represents single intramuscular administration of xeomin into temporal muscles in a dose of 25 units in each frontal and occipital muscle in a dose of 12.5 units. The preventive medication follows the detoxification therapy.

EFFECT: considerable reduction of the recurrence number by relieving the reflex pericranial muscle and expression line tension.

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Description

The invention relates to medicine, namely to neurology, and can be used to treat patients with abusal headache.

Headache is a frequent cause of prolonged disability, disadaptation in the professional activity and everyday life of patients (Rachin A.P., Yudelson Y.B. Patterns of the formation of chronic headache in children and adolescents. Pain syndromes in the head, face and oral cavity // Conference proceedings. Russia. Smolensk. 2010. P.28.).

Headache is the most common cause of independent, unjustified and uncontrolled patient taking medications (Tabeeva G.R. Chronic headache // edited by Professor Golubeva V.L. Selected lectures on neurology. - M .: Eidos Media. - 2006. p. .144-145).

Uncontrolled, unjustified and increasing use of a variety of analgesic drugs for a long time, sometimes for years, including for preventive purposes, over time leads to the loss of their effectiveness, chronic headache (Kraaimaat F., Evers A. Pain coping strategies in chronic pain patients: psychometric characteristics of the pain coping inventory (PCI) // Int. J. Behav. Med. - 2003. - V. 10. - No. 4. - P.343-363) and the acquisition of a headache of a different nature.

Headache caused by excessive intake of medications is called abusal headache (Feoktistov A.P., Filatova E.G., Wayne AM. Abuse headache // Journal of Neurology and Psychiatry named after S. S. Korsakov. Volume 99. No. 12. 1990. P.58-61; Headache Classification Committee of the International Headache Society. (IHS). The International Classification of Headache Disorders, 3-rd edition (beta version). Cephalgia. 2013. P.639).

However, existing methods of treating patients with abusal headache are not effective enough, they are accompanied by a relapse of headache, because they do not eliminate the formed dysfunction of the nociceptive system and do not eliminate the reflex muscle spasm that causes a vicious cycle of chronic headache (Wheeler A.N. Botulinum toxin A, adjunctive therapy for refractory headaches associated with pericranial muscle tension. Headache. Vol. 38. No. 6. 1998. P.468-471).

According to the results of studies on the scientific, medical and patent literature, we have found various methods of treating patients with abusal headache.

So in the work of Osipova V.V., Tabeeva G.R. (Primary headaches // Practical guide. Moscow. 2007. P.43) describes a method of treating patients with an abusic headache, which consists in explaining to the patient the mechanism of formation of an abusic headache, the gradual complete cancellation of analgesic drugs, alleviating withdrawal symptoms and prescribing specific therapy.

In the work of Starikova N.L. (Chronic daily headache // Methodological recommendations for students of the Faculty of Advanced Medical and Internal Medicine. Perm. 2001. P.8-9) describes a method of treating patients with abusal headache, which includes cancellation of the guilty drugs, psychotherapy, biological feedback methods and, if necessary, mild substitution therapy in the form of sedative, hypnotic and antiemetic drugs.

In the work of Azimova Yu.E., Tabeeva G.R. (Headache associated with excessive intake of drugs (abusal headache) // Farmateka. 2012. No. 6. P.10-14) describes a method of treating patients with abusal headache, which consists in the abolition of drugs and prophylactic treatment at least at least for 6 months.

In the work of Tabeeva G.R. (Chronic daily headache // Edited by Golubeva V.L. Selected lectures on neurology. M .: Eidos Media. - 2006. P.150-151) describes a method of treating patients with abusal headache, which consists in the complete abolition of analgesic drugs, the use of antidepressants, non-drug methods of treatment and behavioral therapy.

In the work of Alekseev V.V., Yakhno N.N. (Headache. A guide for doctors. Diseases of the nervous system // Edited by Academician of RAMS Professor Yakhno NN Volume 2. M.: “Medicine”. 2005. P.281-282) describes a method for treating patients with abusal headache, consisting in the abolition of analgesic drugs, the appointment of antidepressants in combination with non-drug methods of treatment and behavioral therapy.

In the work of Marco Mumentaler, Heinrich Mattle (Neurology // Translated from German. Edited by Levin OS - M .: MEDpress-inform. 2007. P.774) a method for treating patients with abusal headache is described, which involves a gradual reduction doses of analgesic drugs against the background of the appointment of antidepressants, psychotherapeutic support using behavioral therapy methods.

In the work of Meshkova A.O., Rybak V.A. (Agomelatine (Valdoxan) and transcranial electrical stimulation in the complex treatment of abusal headache and in the correction of comorbid conditions accompanying it // Bulletin of the Volgograd State Medical University. 2012. No. 3. P.96-99) describes a method of treating patients with abusal headache, which provides performing 10 sessions of transcranial electrical stimulation and taking valdocane in a dosage of 25 mg once a night, for a period of at least 2 months.

In the work of Thomas Tsegl, Andre Gottschalk (Treatment of pain. Handbook // Translation from German, edited by A. Barinova. Third edition. M.: MEDpress-inform. 2012. P.309) describes a method of treating patients with an abusal head pain, involving the abolition of analgesics, the appointment of anti-migraine drugs, the mood of the patient, his motivation, and psychological support.

In the work of Rossi P., Lorenzo C, Faroni J., et al. (Advice alone vs. structured detoxification programs for medication overuse headache: a prospective, randomized, open-label trial in transformed migraine patients with low medical needs. Cephalagia. 2006. No. 26: 1097-1105) describes a method for treating patients with an abusic headache , which provides for the abolition of analgesic drugs, the appointment of prednisone, antiemetics, rehydration.

RF patent No. 2321387 (publ. 2008, BIPM No. 10) protected "Method for the treatment of chronic daily headache." Carry out auto-training, rational, suggestive, family psychotherapy, carry out superficial multi-needle acupuncture, percutaneous electrical stimulation, acupressure and deep massage of the cervical-collar zone. Carry out a massage of the scalp, color and music therapy.

The disadvantage of all of the above methods of treating patients with abusal headache is their lack of effectiveness due to relapse of headache in patients.

The closest in technical essence and adopted as a prototype is a method of treating patients with abusal headache, described in the work of Osipova V.V. et al. (Primary headaches: clinic, diagnosis, therapy // Information letter (for neurologists, therapists, general practitioners). - Rostov-on-Don. 2011. P.36-38).

The method provides for the abolition of analgesic drugs that led to the formation of an abusal headache, detoxification therapy, alternative pain relief, preventive and behavioral therapy.

Detoxification therapy is performed for a course of 7 days: 7 droppers in the morning and 7 droppers at night. In the morning, dexamethasone 4-8 mg and magnesia 10 ml diluted in 200 ml of a 0.9% NaCl solution, in the evening - amitriptyline 2 ml, or relanium, diluted in 100 ml, 0.9% NaCl solution.

Alternative anesthesia - instead of analgesic drugs that lead to the formation of an abusal headache, catadalon is prescribed 1 tablet 3 times a day, in a course of 4-5 weeks.

Preventive therapy, which begins to be carried out simultaneously with detoxification, involves the introduction of:

- prednisone 60-100 mg in the morning with a gradual dose reduction every 3-4 days by 30 mg per day, treatment duration up to 4 weeks, plus omeprazole 20 mg 1 time per night;

- or anticonvulsants: topiramate 100 mg per day, valproic acid 1000 mg per day, gabapentin 300 mg per day, for 3-6 months;

- or antidepressants: amitriptyline up to 75 mg per day, selective serotonin reuptake inhibitors, selective serotonin and norepinephrine reuptake inhibitors, for 3-6 months.

Behavioral therapy provides an explanation to the patient of the risk of developing an abusic headache in case of abuse of painkillers and the need to discontinue analgesic drugs that led to the formation of abusal headache.

The disadvantage of the prototype is the lack of effectiveness in the treatment of patients with abusal headache due to a relapse of the disease observed in 40% of patients.

The task of the invention is to develop a highly effective method of treating patients with abusal headache.

The technical result is to increase the effectiveness of treatment of patients with abusal headache due to a significant reduction in the number of cases of relapse.

The technical result is achieved in that the treatment of patients with an abusal headache includes the abolition of analgesic drugs that lead to the formation of an abusal headache, the conduct of detoxification therapy, alternative pain relief, preventive and behavioral therapy. Preventive therapy is performed after the end of the course of detoxification therapy; for this, the Xeomin preparation is administered intramuscularly once: in the temporal muscles - in a dose of 25 units in each, in the frontal and occipital muscles - in a dose of 12.5 units in each.

In his work Artemenko A.R. (Chronic daily headaches: Chronic migraine. Pain syndromes in the head, face and oral cavity. Conference proceedings. Russia. Smolensk. 2010. P.35-45) notes that an important factor in the pathogenesis of headaches, along with the development of sensitization of nociceptors and central nociceptive neurons, is the reflex tension of pericranial and facial muscles. The resulting muscle spasm becomes not only an additional source of pain, but also forms a vicious circle that provides chronic pain (Wheeler A.N. Botulinum toxin A, adjunctive therapy for refractory headaches associated with pericranial muscle tension. Headache. Vol.38. No. 6 1998. P.468-471).

The drug "Xeomin", registration number LSR-004746/08 of 08/08/2010. Pharmacological group: peripheral muscle relaxant. Xeamine acts selectively on peripheral cholinergic nerve endings, inhibiting the release of acetylcholine. The final effect is relaxation of the injected muscle. The effect of each procedure lasts, as a rule, three to four months.

Detailed description of the method

Treatment of patients with abusal headache includes the abolition of analgesic drugs that led to the formation of abusal headache, the conduct of detoxification therapy, alternative pain relief, preventive and behavioral therapy.

After the initial examination and history, the patient with abusal headache is canceled all previously used analgesic drugs that led to the formation of abusal headache. Simultaneously with the abolition of these analgesic drugs, they begin to carry out detoxification therapy, if necessary, alternative analgesia, behavioral therapy.

Detoxification therapy is performed for a course of 7 days: 7 droppers in the morning and 7 droppers at night. In the morning, dexamethasone 4-8 mg and magnesia 10 ml diluted in 200 ml of a 0.9% NaCl solution, in the evening - amitriptyline 2 ml, or relanium, diluted in 100 ml, 0.9% NaCl solution.

Alternative anesthesia - instead of analgesic drugs that led to the formation of an abusic headache, if necessary, the patient is not previously used analgesic drug, the course until the disappearance of the abusous headache.

Behavioral therapy - they explain to the patient with an abusic headache the reasons for its occurrence, explain the need to cancel analgesic drugs that led to the formation of an abusic headache, convince the patient that their cancellation is one of the main stages of getting rid of an abusic headache.

Preventive therapy is carried out after the end of the course of detoxification therapy. To do this, the patient is injected once intramuscularly with the drug Xeomin: in the temporal muscles - in a dose of 25 units in each, in the frontal and occipital muscles - in a dose of 12.5 units in each.

The practical feasibility of the proposed method is illustrated by an example from clinical practice.

Example: patient Y., 28 years old, case history No. 052355/313, was admitted to the neurology clinic of the Rostov State Medical University (Rostov State Medical University) with a diagnosis of abusal headache. Patient I. suffers from a headache for 6 years. Patient I. complained of constant daily headaches of a pressing diffuse nature. It was revealed that patient Y. was taking various analgesic drugs: imigran, pentalgin, analgin, citramon, baralgin, midocal, ketorol, which became ineffective. The total number of tablets that she took during the month ranged from 94 to 104 tablets. According to the results of magnetic resonance imaging of the brain, patient Y. did not reveal any signs of an organic pathology of the central nervous system.

Patient I. with an abusal headache was treated according to the claimed method.

After the initial examination and examination of the patient’s medical history, Ya with an abusal headache, all previously used analgesic drugs that led to the formation of an abusal headache were canceled. At the same time as they were canceled, they began to carry out detoxification therapy with a course of 7 days: 7 droppers in the morning and 7 droppers at night. In the morning, dexamethasone 4-8 mg and magnesia 10 ml diluted in 200 ml of a 0.9% NaCl solution, in the evening - amitriptyline 2 ml, or relanium, diluted in 100 ml, 0.9% NaCl solution. Alternative pain relief was performed: instead of canceled analgesic drugs, patient Y. was administered orally catadalone 1 tablet 3 times a day and behavioral therapy was carried out - patient Y. was explained the causes of abusal headache, the need for withdrawal of analgesic drugs that led to the formation of abusal headache was explained, convinced That their cancellation is one of the main stages of getting rid of abusal headache.

After the end of the course of detoxification therapy, the patient Y. was given prophylactic therapy: for this, the Xeomin preparation was injected once intramuscularly: 25 units per each in the temporal muscles, 12.5 units each in the frontal and occipital muscles.

On the 10th day after the start of treatment of the patient, Y. noted the complete disappearance of the headache, and alternative pain relief was canceled.

On day 11 after the start of treatment, patient Y. was discharged from the clinic in satisfactory condition.

Control examinations of patient Y., who was treated according to the claimed method, did not reveal any signs of relapse of an abusal headache.

According to the proposed method in the neurology clinic of Rostov State Medical University, 15 patients with abusal headache were treated. A study of the follow-up history of these patients revealed a relapse of abusal headache in one (6.7%) patient.

Thus, in comparison with the prototype, the proposed method can significantly increase the effectiveness of the treatment of patients with abusal headache, reducing the number of cases of relapse by about 6 times.

Claims (1)

A method of treating patients with abusal headache, including the abolition of analgesic drugs leading to the formation of abusal headache, the conduct of detoxification therapy, alternative analgesia, preventive and behavioral therapy, characterized in that prophylactic therapy is performed after completion of the course of detoxification therapy, for this purpose, intramuscularly is administered once Xeomin preparation: in the temporal muscles - in a dose of 25 units in each, in the frontal and occipital muscles - in a dose of 12.5 units in each.