Cefaleia por uso excessivo de medicamentos: das alterações cerebrais ao impacto da doença
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https://doi.org/10.48208/HeadacheMed.2025.36Palavras-chave:
Uso excessivo de medicamentos, Distúrbios da enxaqueca, Sensibilização central, Sistema trigeminovascular, Cefaleia crônicaResumo
Introdução
A cefaleia por uso excessivo de medicamentos é uma cefaleia secundária que se desenvolve em pacientes com cefaleia primária preexistente, geralmente enxaqueca, que apresentam cefaleias diárias ou quase diárias como resultado do uso excessivo de medicamentos sintomáticos. De acordo com os critérios da ICHD-3, o diagnóstico requer ≥15 dias de cefaleia por mês e ≥10–15 dias por mês de uso de medicamentos, dependendo da classe do fármaco, por pelo menos três meses.
Objetivo
Revisar os mecanismos fisiopatológicos, fatores de risco, impacto clínico e características regionais, destacando as implicações terapêuticas e as lacunas de pesquisa atuais.
Métodos
Foi realizada uma revisão narrativa da literatura recente de alta qualidade indexada no PubMed, integrando dados clínicos, epidemiológicos e experimentais, para garantir uma cobertura abrangente das evidências emergentes.
Resultados
A fisiopatologia envolve a desregulação do sistema trigeminovascular, hiperexcitabilidade cortical, neuroplasticidade mal adaptativa e disfunção dos circuitos dopaminérgicos de recompensa, apresentando paralelos com transtornos aditivos. Os principais fatores de risco incluem sexo feminino, alta frequência basal de cefaleia, comorbidades psiquiátricas, vulnerabilidade socioeconômica e predisposição genética. Alterações nos sistemas CGRP e endocanabinoides podem aumentar ainda mais a suscetibilidade. Na América Latina, a ergotamina continua sendo o medicamento mais frequentemente utilizado em excesso, diferentemente dos triptanos e analgésicos simples em países desenvolvidos, o que evidencia disparidades regionais e preocupações com a segurança.
Conclusão
A cefaleia por uso excessivo de medicamentos é um distúrbio evitável, porém subdiagnosticado, com grande impacto pessoal e socioeconômico. O diagnóstico precoce, a educação do paciente e do médico e o manejo eficaz da desintoxicação são essenciais. Lacunas persistentes na fisiopatologia, nos biomarcadores e nas terapias personalizadas exigem mais pesquisas colaborativas e multicêntricas.
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Copyright (c) 2025 María Teresa Reyes Alvarez, Manuel Gudiño Castelazo, Marisol Jannet Figueroa Medina, Marta Veronica González, César Augusto Saavedra Rocha, Silvina Mariel Miranda, Miguel Angel Morales Morales, Rogelio Dominguez-Moreno, Margareth Alexandra Contreras Martínez, Abouch V KrymchantowskI, Jose Miguel Láinez (Author)
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