Psychosomatic Perspectives and Approaches to Medication-Overuse Headache(<Special Issue>A Psychosomatic Study of Headache)

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  • 薬物乱用頭痛への心身医学的考え方とアプローチ(<特集>頭痛の心身医学)
  • 薬物乱用頭痛への心身医学的考え方とアプローチ
  • ヤクブツ ランヨウ ズツウ エ ノ シンシン イガクテキ カンガエカタ ト アプローチ

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Abstract

Medication-overuse headache (MOH) is caused by daily use of analgesics due to severe headache such as migraine. Withdrawal therapy is the only treatment of choice for this condition. However, it is difficult for the patient to discontinue the drug only with instruction, direction, and management by doctor. In a recent study, the relapse rate after successful withdrawal therapy was 38% in the first year and around 42% after 4 years, therefore the prevention of relapse is an important issue. It is neccesary to lead the patients to withdwal therapy not only with medical approaches such as medication, life-style guidance and headache-education but also with psychosomatic approaches including accepting, supporting, reassuring, self monitoring, scaling, autogenic traning, cognitive behavioral therapy, solution focused approach, transactional analysis and redecision therapy. Common denominators of the patients who succeeded to discontinue drugs suggest that they understood MOH mechanisms well enough and had a spontaneous will to stop drugs. In the treatment of MOH, it is necessary to treat patients with following four strategic stages: Awareness-Realizing-Decision-Action based on the "discount" model and psychosomatic approach which can bring out their spontaneity.

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