How to choose tight headache drugs in different periods?Dry sorting, it is recommended to collect it!

The global prevalence of tension headaches is 11%to 45%. It is the second highest incidence disease in the world second only to dental caries. It is also the most common (45.3%) primary headache in my country.The 2018 global illness burden research shows that tension headaches are the second cause of chronic diseases and injuries.Tastest headaches often merge mental and psychological disorders with the frequency of attacks. Among them, anxiety and depression are the most prominent, and then further aggravate its disease burden.The annual prevalence of tight headaches in my country is 10.8%, and the east is higher than the west. The proportion of men and women is about 1: 1.81, reaching its peak at the age of 40 to 49.

With reference to the International Headache Classification 版 3rd edition (ICHD‑3), tension headaches are divided into 4 categories, as shown in Figure 1.

Figure 1 Tight headache classification

Tension -type headache drug treatment is divided into acute treatment and preventive treatment.

1. Acute stage treatment

1. Acute stage treatment goals and principles

(1) Treatment goals

The core goal of drug treatment during acute seizures is to quickly alleviate pain, reduce economic and medical resources consumption, and improve the quality of life.

(2) Treatment principles

The treatment plan should be formulated according to the severity of the headache, the frequency of the occurrence, and the individual factors of the patient.When the tense headache is mild, non -drug treatment such as rest.It can evaluate the frequency of tension headache and the degree of impact on patient life and work through headache loss time 0 90 (Halt‑90) meter, and formulate diagnosis and treatment plans in conjunction with the patient’s wishes.Patients (≤2 d/weeks) who are not frequent in headaches, and can be treated with a single component of the minimum effective dose during headache.During the treatment, opioids, Babady drugs, Anto and Quaputan drugs should be avoided.

(3) Efficiency evaluation

① There is no pain after taking the medicine for 2 h; ② The degree of pain is reduced; ③ the treatment response lasted for 24 h; ④ the quality of life and health related to health; ⑤ decreased incidence of adverse events.

(4) Treatment adjustment

Patients with uncommon headache (≤2 d/weeks), when a single analgesic drug has no good curative effect, caffeine and composite preparations for acetaminol, aspirin or ibuprofen.When headaches are more frequent (> 2 d/weeks), chronic tension headache, tension headache and disease, symptomatic treatment is invalid, the drug treatment time is required. At this time, preventive treatment is needed to avoid excessive use of analgesic drugs.

2. Acute treatment drugs

Taking acetaminol or non -steroidal anti -inflammatory drugs (NSAIDS) as the preferred drug, compound analgesic drugs with the combination of caffeine are used as second -line therapy drugs. See Table 1.

Table 1 Recommended medication for tension headaches

The headaches of most patients with tension -type headache are mild to moderate. It is recommended to use simple analgesic and non -steroidal anti -inflammatory drugs as the preferred drug for symptomatic treatment during acute headache.Commonly used drugs include acetaminol and NSAIDS, such as aspirin, ibuprofen, 萘puzon, bislofenate, etc.

(1) Acetaminol

Also known as heating and polygay, it belongs to an analgesic drugs of aniline, which is a simple analgesic drug with a weak anti -inflammatory effect.

Recommended dose: 500 ~ 1000 mg/time, the daily maximum dose of 4000 mg (class I recommendation, level A evidence).

Adverse reactions: liver, kidney, blood toxicity, etc.

Note: The treatment of tense headache for acetaminol is not as effective as aspirin, but its gastrointestinal adverse reactions are relatively mild.There are certain liver and kidney toxicity. During the period of use, you must not drink alcohol or drink alcoholic beverages.

(2) Borprofen

Ibuprofen belongs to the NSAIDS of goghopropine. For the tension of the seizure, the analgesic effect of ibuprofen is stronger than the acetaminol.

Recommended dosage: 200 ~ 800 mg/time, the daily maximum dose of 800 mg (grade I recommendation, A -level evidence).

Adverse reactions: bleeding syndrome, indigestion, nausea, diarrhea, constipation, dizziness, fatigue, etc.

Note: Severe liver, renal insufficiency, active ulcers, allergies, bleeding risks, and pregnancy are the main taboos.

(3) Dicosecar

Dipluminic acid belongs to NSAIDS of Fenylcetate, and the analgesic effect is stronger than that of Paton and Mi Meixin.Sodium sodium sodium can effectively relieve tension headaches, which is equivalent to ibuprofen.

Recommended dosage: 12.5 ~ 100.0 mg/time, the daily maximum dose of 150 mg (class I recommendation, A -level evidence).

Adverse reactions: bleeding syndrome, indigestion, nausea, diarrhea, constipation, dizziness, fatigue, etc.

Note: Severe liver, renal insufficiency, active ulcers, allergies, bleeding risks, and pregnancy are the main taboos.

(4) Aspirin

Aspirin belongs to NSAIDS of salicylic acid, which has relatively strong anti -inflammatory effects and can relieve mild and moderate pain.

Recommended dose: 250 ~ 1000 mg/time, the daily maximum dose of 3,000 mg (class I recommendation, A -level evidence).

Adverse reactions: digestive diseases, bleeding, allergies, etc.

Note: It is recommended to take it after meals. Patients with stomach problems should be avoided.Due to the risk of Reye syndrome, preparations including aspirin should not be provided to patients under 16 years old.

(5)

Adverse reactions: adverse gastrointestinal reactions, such as nausea, stomach discomfort, and bleeding risk.

Note: Those who are accompanied by the history of gastrointestinal ulcers should be used with caution, and pregnant women and lactating women should not apply.

Recommended dose: 275 ~ 550 mg/time, the daily maximum dose of 1,000 mg (class I recommendation, level A evidence).

(6) ketones

The results of the previous random placebo -controlled test showed that the 25 mg or 50 mg of the ketonone can significantly reduce the tension headache and reduce the duration of headache.

Recommended dosage: 25 mg/time or 50 mg/time, the daily maximum dose of 200 mg (class I recommendation, A -level evidence).

Adverse reactions: bleeding syndrome, indigestion, nausea, diarrhea, constipation, dizziness, fatigue, etc.

Precautions: Severe liver and renal dysfunction, active ulcers, allergies, bleeding risks, pregnancy, etc. are the main taboos

(7) Compound preparations containing caffeine

Recommended dosage: 1 tablet/time, 2 tablets daily, 2 tablets (class II recommendation, level A evidence).

Adverse reactions: nausea, drowsiness and fatigue.

Note: Caffeine ring can cause headaches. At the same time, compound analgesic drugs containing caffeine will increase the probability of excessive use of drugs and avoid excessive use.

3. Avoid the use of drugs in the acute stage

Others, Barbich, Quputan, and Aojin drugs have poor treatment effect on the acute seizure of tension headaches, and there is risk of increasing the risk of over -use headache or other serious adverse reactions.Avoid use.

2. Preventive drug treatment

1. Preventive treatment goals and principles

Before the treatment, we should fully communicate with the patients, and choose individualized treatment plans based on evidence -based medical evidence, doctors’ professional experience, common diseases, special population, drug tolerance, medication preferences, taboos and allergies, and treatment costs.

Preventive treatment goals and principles are as follows:

(1) Treatment purpose: reduce the frequency of headache; reduce the degree of headache and shorten the duration; improve the efficacy of acute treatment, reduce acute treatment consumption, and avoid excessive use of drugs for drugs; reduce disability and improve quality of life.

(2) Treatment indicators: When headaches are more frequent (> 2 d/weeks); the degree of improvement of non -drug treatment and acute stage treatment is not obvious; there is a risk of excessive use of drugs;Obstacles, etc., can be considered for preventive treatment.

(3) Evaluation of efficacy: Evaluate changes in the frequency of headache and the degree of headache through the diary of consultation and headache; the evaluation of health status and health -related quality of life; decreased incidence of adverse events; and decreased in acute treatment drugs.

(4) Treatment adjustment: When a single drug has poor curative effect, you can consider the combination of multiple drugs or drugs and non -drug therapy, and strengthen the management of common diseases and risk factors;Chronic tension headache may be maintained for 12 months with excessive drug users, and then you can consider gradually discontinuation.

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