619

Thammasat Medical Journal, Vol. 11 No. 4, October-December 2011

*
(medication overuse
headache, MOH)

triptan
drug-induced headache, rebound headache
medication - misuse headache







, NSAIDs, ,

headache
attributed to a substance or its withdrawal
International Headache Society (IHS)
..
(chronic daily headache,
CDH)

CDH

(tension
type headache, TTH) .
MOH
IHS ..

(drug-induced headache)

..

MOH
MOH

opioid, ,


MOH
.
probable MOH (..)

- (

) /

619-624.indd 619

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620

MOH IHS: ICHD-II (2005)

Medication-overuse headache (MOH) (8.2)
A. Headache presents on 15 days/month fulfilling criteria C and D.
B. Regular overuse for 3 months of one or more drugs that can be taken for acute and/or symptomatic
treatment of headache.
C. Headache has developed or markedly worsened during medication overuse.
D. Headache resolves or reverts to its previous pattern within 2 months after discontinuation of overused
medication.

MOH IHS: ICHD-II (2005)

Ergotamine-overuse headache (8.2.1)
Ergotamine intake on 10 days per month on a regular basis for >3 months
Triptan-overuse headache (8.2.2)
Triptan intake (any formulation) on 10 days per month on a regular basis for >3 months
Analgesic-overuse headache (8.2.3)
Intake of simple analgesics on 15 days per month on a regular basis for >3 months
Opioid-overuse headache (8.2.4)
Opioid intake on 10 days per month on a regular basis for >3 months
Combination analgesic-overuse headache (8.2.5)
Intake of combination analgesic medications on 10 days per month on a regular basis for >3
months
Medication-overuse headache attributed to the combination of acute medications (8.2.6)
Intake of any combination of ergotamine, triptans, analgesics, and/or opioids on 10 days per
month on a regular basis for >3 months without overuse of any single class alone
Headache attributed to other medication overuse (8.2.7)
Regular overuse for >3 months of a medication other than those described above
Probable medication-overuse headache (8.2.8)
A. Headache fulfilling criteria A, C, and D for 8.2
B. Medication overuse fulfilling criterion B for any one of the subforms 8.2.1 to 8.2.7
C. One or other of the following:
1. Overused medication has not yet been withdrawn
2. Medication overuse has ceased within the last 2 months but headache has not yet resolved
or reverted to its previous pattern

619-624.indd 620

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621

Thammasat Medical Journal, Vol. 11 No. 4, October-December 2011

(tolerance)

(rebound
effect)
(central sensitization)

(noxious) (non-noxious
stimuli)

N-methyl-D-aspartate (NMDA
receptor)

(allodynia)

619-624.indd 621

, polymorphism
, corticotrophin releasing factor
orexin , growth hormone ,
endocarnabinoid


(fear and catastrophism from pain) (operant
conditioning)
(bipolar
disorder)




, ,

(-)

MOH tricyclic
antidepressant, selective serotonin reuptake

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622

inhibitor
beta-blocker
valproic acid topiramate





,




(detoxification program)



()

NSAIDs , ,

phenobarbital
Bellergal, butobarbital Belloid

()

NSAIDs (
)

-

NSAIDS

619-624.indd 622

opioid, benzodiazepine
barbiturate
-


dihydroergotamine
.- . metoclopramide
.
neuroleptics
prochlorperazine, chlorpromazine, droperidol

-
-
CDH MOH .



(
.) amitryptyline
( .)


topiramate
- ./
. /

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Thammasat Medical Journal, Vol. 11 No. 4, October-December 2011

,







MOH

,

. . .
;:-.
. , .
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