RU2547565C1 - Method of treating patients with abuse headache - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: analgesic preparations caused the onset of abuse headache are withdrawn; detoxification therapy, alternative anaesthesia, preventive and behavioural therapy follow. The detoxification therapy represents a 10-day therapeutic course according to the schedule: Cytoflavin 10 ml dissolved in 0.9% NaCl 200 ml is administered intravenously drop-by-drop daily in the morning and evening. Additionally, Milgamma 2.0 ml is injected intramuscularly daily in the morning; Reamberin 200-400 ml is administered intravenously drop-by-drop every second day.

EFFECT: treating the patients with abuse headache and reducing the number of recurrences.

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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 pain in the area of the cranial vault upward from the eyebrows, to the back of the head and inside of it (Skoromets A.A., Skoromets A.P., Skoromets T.A. Topical diagnosis of diseases of the nervous system. A guide for doctors. 5th stereotyped edition .-- St. Petersburg: Polytechnic, 2005. P.228). Headache is the most universal complaint of a person and can be a symptom of more than 300 different diseases, which leads to different approaches to determining a qualitative approach to its treatment (Rasmussen VK, Epidemiology of headache. Cephalagia, 2001. - V.21, No. 7, P .774-777).

Headache is the most common reason for taking analgesic drugs and a reason for independent, unjustified and uncontrolled patient taking medications (Tabeeva G.R. Chronic headache. / Ed. By Prof. Golubeva V.L. Selected lectures on neurology. - M. : Eidos Media. - 2006. S.144-145).

Self-medication leads to an increasing uncontrolled, unjustified intake of various medications for a long time, sometimes for years. In some cases, as prescribed by a doctor, patients take medications to prevent the onset of a headache attack. Prolonged and uncontrolled administration of analgesic drugs over time leads to 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, often to mask the primary form of headache, for which the administration of analgesic drugs was started.

A headache caused by overuse of drugs is called an abusic 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) and is accompanied by the formation of a nociceptive system dysfunction ( Osipova VV, et al. Primary headaches: clinic, diagnostics, therapy / Information letter (for neurologists, therapists, doctor th general practice.) - Rostov-on-Don, 2011. P.35)..

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. A 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. Guidelines for students of the Faculty of Advanced Studies for Doctors and Interns. Perm. 2001. P.8-9) describes a method of treating patients with an abusic headache, which includes canceling the culprit drugs, conducting psychotherapy, biological feedback methods and , if necessary, mild replacement 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 medicines (abusal headache) Farmateka. 2012. No. 6, pp. 10-14) describes a method of treating patients with abusic headache, which consists in the abolition of drugs and preventive treatment, at least , for 6 months.

In the work of Tabeeva G.R. (Chronic daily headache / Edited by V. Golubev. Selected lectures on neurology. M .: Eidos Media. - 2006. P.150-151) describes a method of treating patients with an abusic 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. / Ed. By Acad. RAMS, Prof. Yakhno NN Volume 2. M .: "Medicine". 2005. P.281-282) describes a method of 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 provides gradual reduction in the dose 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 Volgograd State Medical University. 2012. No. 3. P.96-99) describes a method of treating patients with abusal headache, which involves performing 10 sessions of transcranial electrical stimulation and administration of valdoxan in a dosage of 25 mg once a night, for a period of at least 2 months.

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; 26: 1097-105) describes a method for treating patients with abusal headache, which includes the abolition of analgesic drugs, the appointment of prednisone, antiemetics, rehydration.

RF patent No. 2321387 (publ. 2008, BIPM No. 10) protected "A 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.

However, often existing methods of treating patients with abusal headache become ineffective, accompanied by a relapse of headache, since they do not eliminate the formed dysfunction of the nociceptive system.

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 0.9% NaCl solution, in the evening - 2 ml amitriptyline (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 pain medication and the need to cancel analgesic drugs that led to the formation of an 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 abusal headache observed in 40% of patients, due to the lack of correction of the resulting dysfunction in the nociceptive system.

The objective of the invention is to increase the effectiveness of treatment of patients with abusal headache by reducing relapse of the disease.

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 led to the formation of an abusal headache, detoxification therapy, alternative pain relief, preventive and behavioral therapy. Detoxification therapy is carried out in a 10-day course according to the scheme: daily, morning and evening, the patient is injected intravenously with cytoflavin at a dose of 10 ml diluted in 200 ml of a 0.9% NaCl solution, while daily, in the morning, the patient is additionally intramuscularly injected with 2.0 ml of milgamma; every other day in the afternoon, the patient is injected intravenously with reamberin in a dose of 200-400 ml.

Reamberin: registration number P No. 001048/01 of 07/20/2010, pharmacotherapeutic group: detoxification agent. It has antihypoxic and antioxidant effects. In addition, reamberin has a positive effect on aerobic processes in the cell, reducing the production of free radicals and restoring the energy potential of cells.

Cytoflavin: registration number P No. 003135/01 of 11/21/2008, pharmacotherapeutic group: metabolic agent. Cytoflavin increases the resistance of the membranes of nerve cells and glial cells to the effects of ischemia, which is expressed in a decrease in the concentration of neurospecific proteins that characterize the level of destruction of the main structural components of the nervous tissue. Cytoflavin has an antihypoxic, antioxidant effect, positively affects the processes of energy production in the cell, reducing the production of free radicals and restoring the activity of antioxidant enzymes.

Milgamma: registration number P No. 012551/02, pharmacotherapeutic group: B vitamins, etc. The composition of the drug includes pyridoxine, thiamine, cyanocobalamin. Cyanocobalamin increases the ability of tissues to regenerate, is involved in the synthesis of the myelin sheath, and reduces the pain associated with damage to the peripheral nervous system. Thiamine plays an important role in the metabolism of carbohydrates, as well as in the Krebs cycle with subsequent participation in the synthesis. Pyridoxine is involved in the metabolism of protein, partly in the metabolism of carbohydrates and fats. The physiological function of both vitamins is the potentiation of each other's actions, manifested in a positive effect on the nervous, neuromuscular, and cardiovascular systems.

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, 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 all other stages of treatment.

Detoxification therapy is performed according to the scheme: daily, morning and evening, the patient is given intravenous drip of cytoflavin in a dose of 10 ml, diluted in 200 ml of a 0.9% NaCl solution. Also daily, but in the morning, the patient is additionally intramuscularly injected with a 2.0 ml milgamma. And in a day, and only in the afternoon, the patient is injected intravenously with reamberin in a dose of 200 - 400 ml. The course of detoxification therapy is 10 days.

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.

Preventive therapy - antidepressants are administered to the patient: amitriptyline, at a dose of up to 75 mg per day, for 6 months.

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.

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

Example 1:

Patient A., 27 years old, medical history No. 052355/313, was admitted to the neurology clinic of the Rostov State Medical University (Rostov State Medical University) with a diagnosis of Abuse headache. Patient A. suffers from headache for 10 years. On examination, patient A. complained of constant daily intense headaches of a pressing diffuse nature. It was found that patient A. was taking various analgesic drugs: sedalgin, nurofen, instant, pentalgin, citramon p, analgin, nise, relaxax, which became ineffective. In addition, patient A. had irritability, depression, and anxiety in anticipation of an attack of severe headache. According to the results of magnetic resonance imaging of the brain in patient A., there were no signs of an organic pathology of the central nervous system.

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

After an initial examination and anamnesis, the patient A. with abusal headache was canceled all previously used analgesic drugs, which led to the formation of abusal headache. Along with their cancellation, they began to carry out all other stages of treatment.

Detoxification therapy was performed according to the scheme: daily, morning and evening, patient A. was injected intravenously with cytoflavin at a dose of 10 ml, diluted in 200 ml of a 0.9% NaCl solution at a rate of 60 drops per minute. Also daily, but in the morning, patient A. was additionally intramuscularly injected with a 2.0 ml milgamma. And in a day, and only in the afternoon, i.e. in the daytime, patient A. was injected intravenously with a dose of 400 ml of reamberin at a rate of 60 drops per minute. The course of detoxification therapy was 10 days.

Alternative pain relief - instead of canceled analgesic drugs, patient A. was administered orally catadalone, 1 tablet 3 times a day. On day 10 after the start of treatment, patient A. noted a complete disappearance of headache, and alternative pain relief was canceled.

Prophylactic therapy - patient A. was injected with antidepressants: amitriptyline, at a dose of 25 mg per day for 6 months: the first 10 days of treatment - in the clinic, then on an outpatient basis.

Behavioral therapy - the patient A. with an abusal headache was explained the reasons for its occurrence, the need for withdrawal of analgesic drugs leading to the formation of an abusal headache was explained, they were convinced that their abolition was one of the main stages of getting rid of an abusal headache.

On day 11 after the start of treatment, patient A. was discharged in satisfactory condition for outpatient treatment.

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

Example 2:

Patient Yu., 52 years old, medical history No. 051958/307, was admitted to the neurology clinic of the Rostov State Medical University (Rostov State Medical University) with a diagnosis of Abuse headache. Patient Yu suffers from headache for 20 years. On examination, patient Yu complained of constant daily intense headaches of a pressing diffuse nature. It was found that patient Y. over the past 3 years took 7 tablets of various analgesic drugs: citramon p, pentalgin, nurofen, nise, ketorol, analgin, instant, diclofenac, spazmalgon, xefocam. In addition, over the past year, patient Y. in addition to analgesic drugs additionally twice a week injected baralgin in a dose of 5 ml intravenously. In addition, patient Yu had irritability, depression, and anxiety in anticipation of the onset of severe headache attacks. According to the results of magnetic resonance imaging of the brain, patient Yu showed no signs of an organic pathology of the central nervous system.

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

After an initial examination and anamnesis, patient Yu with an abusal headache was canceled all previously used analgesic drugs, which led to the formation of an abusal headache. Simultaneously with the cancellation, they began to carry out all other stages of treatment.

Detoxification therapy was performed according to the scheme: daily, morning and evening, patient Yu was injected intravenously with cytoflavin at a dose of 10 ml diluted in 200 ml of a 0.9% NaCl solution at a rate of 60 drops per minute. Also daily, but in the morning, patient Yu was additionally intramuscularly injected with a 2.0 ml milgamma. And in a day, and only in the afternoon, i.e. in the daytime, patient Yu was given an intravenous drop of reamberin at a dose of 200 ml with an injection rate of 60 drops per minute. The course of detoxification therapy (DT) was 10 days. At the end of the DT course, patient Yu noted a complete disappearance of the headache.

Alternative anesthesia - instead of canceled analgesic drugs, patient Y. was administered orally Catadal 1 tablet 3 times a day. On the 10th day after the start of treatment, patient Yu noted a complete disappearance of headache, and alternative pain relief was canceled.

Prophylactic therapy - patient Yu was injected with antidepressants: amitriptyline, at a dose of 50 mg per day for 6 months: the first 10 days of treatment - in the clinic, then on an outpatient basis.

Behavioral therapy - the patient Yu with an abusal headache was explained the reasons for its occurrence, the need for withdrawal of analgesic drugs that led to the formation of an abusic headache was explained, they were convinced that their abolition was one of the main stages of getting rid of an abusal headache.

On the 11th day after the start of treatment, patient Y. was in satisfactory condition discharged for outpatient treatment.

Control examinations of the patient Yu., 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, 17 patients with abusal headache were treated. A study of the follow-up history of these patients during the year revealed signs of relapse of abusal headache in only 1 (5.8%) patient.

Thus, in comparison with the prototype, the proposed method can significantly increase the effectiveness of the treatment of patients with abusal headache due to a significant reduction in the number of cases of relapse.

Claims (1)

A method of treating patients with an abusic headache, including the abolition of analgesic drugs leading to the formation of an abusal headache, detoxification therapy, alternative pain relief, preventive and behavioral therapy, characterized in that detoxification therapy is carried out in a 10-day course according to the following scheme: daily in the morning and evening for a patient cytoflavin in a dose of 10 ml diluted in 200 ml of a 0.9% NaCl solution is injected intravenously, and the patient is additionally injected intramuscularly daily in the morning milgamma at a dose of 2.0 ml; every other day in the afternoon, the patient is injected intravenously with reamberin in a dose of 200-400 ml.