第51回日本神経学会総会
＜シンポジウム17―2＞片頭痛の疼痛発生とその拡大進展をめぐる最先端の分子メカニズム
片頭痛はなぜ慢性化するのか？慢性片頭痛と薬物乱用頭痛の臨床とメカニズム
竹島 多賀夫
富永病院神経内科・頭痛センター〔〒556―0017 大阪市浪速区湊町1―4―48〕
Chronification of migraine headaches is one of the most urgent issues. Chronic migraine (CM) and medication overuse headache (MOH) are defined in international classification of headache disorders II (ICHD-II). Appendix criteria of CM and MOH were submitted and will take over the original criteria. I described a case of CM and a case of MOH. Here I pointed out some practical issues in diagnosis of CM or MOH. 1) It is not easy to define the association of headache worsening and the beginning of medication overuse in many cases. 2) Some patients cannot discontinue the overused drugs; therefore, the diagnosis of CM nor MOH cannot be completed. 3) Some patients are not released from their headache even after the discontinuation of drug. In these cases, there are two possibilities. As a result of CM, the patient had simply overused the ineffective medications. From another point of view, MOH caused irreversible brain changes and MOH do not disappear after the detoxification. 4) In a practical management, we often prescribe preventive medications simultaneously at the beginning of detoxification. In these cases, it is unclear which one of the detoxification or the preventive medication contributes the improvement of headache. The chronification of migraine is regarded as chronification of acute mechanism of migraine, i.e., inflammation of the trigeminovascular system and sensitization of the brain. Apart from medication overuse, there have been reported some new risk factors for migraine chronification, including frequent headache, female sex, obesity, low income, low education, stress by life events, depression, snoring, sleep disorders, and past history of neck or head injury. Chronification of migraine severely disturbs the quality of patient's life. More attention should be paid and the further and extensive studies are urgently necessary.
Full Text of this Article in Japanese PDF (262K)
(臨床神経, 50：990−993, 2010)
key words：国際頭痛分類，慢性連日性頭痛，危険因子，診断基準，肥満
（受付日：2010年5月22日）
