<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2182-5173</journal-id>
<journal-title><![CDATA[Revista Portuguesa de Medicina Geral e Familiar]]></journal-title>
<abbrev-journal-title><![CDATA[Rev Port Med Geral Fam]]></abbrev-journal-title>
<issn>2182-5173</issn>
<publisher>
<publisher-name><![CDATA[Associação Portuguesa de Medicina Geral e Familiar]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2182-51732021000600578</article-id>
<article-id pub-id-type="doi">10.32385/rpmgf.v37i6.12882</article-id>
<title-group>
<article-title xml:lang="pt"><![CDATA[Quando o tratamento se torna causa da doença]]></article-title>
<article-title xml:lang="en"><![CDATA[When treatment becomes the cause of the disease]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Oliveira]]></surname>
<given-names><![CDATA[Jaime]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peixoto]]></surname>
<given-names><![CDATA[Fabiana]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Monteiro]]></surname>
<given-names><![CDATA[Joana Silva]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,ACeS Grande Porto III - Maia/Valongo USF Odisseia ]]></institution>
<addr-line><![CDATA[Maia ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,ACeS Grande Porto III - Maia/Valongo USF Pedras Rubras ]]></institution>
<addr-line><![CDATA[Maia ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,ACeS Grande Porto III - Maia/Valongo USF Odisseia ]]></institution>
<addr-line><![CDATA[Maia ]]></addr-line>
<country>Portugal</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidade do Porto Faculdade de Medicina ]]></institution>
<addr-line><![CDATA[Porto ]]></addr-line>
<country>Portugal</country>
</aff>
<pub-date pub-type="pub">
<day>30</day>
<month>12</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>30</day>
<month>12</month>
<year>2021</year>
</pub-date>
<volume>37</volume>
<numero>6</numero>
<fpage>578</fpage>
<lpage>584</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_arttext&amp;pid=S2182-51732021000600578&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_abstract&amp;pid=S2182-51732021000600578&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.pt/scielo.php?script=sci_pdf&amp;pid=S2182-51732021000600578&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo  Introdução:  A cefaleia é uma queixa frequente, não sendo raros os casos de automedicação. Este artigo relata a abordagem da cefaleia por uso excessivo de medicamentos (CUEM) numa doente automedicada com analgésicos, cuja intervenção foi dificultada pela má adesão ao acompanhamento médico.  Descrição do Caso:  Mulher de 41 anos, empregada de limpeza. Antecedentes de enxaqueca desde a adolescência, agravada depois do segundo parto, com episódios semanais, sem alívio após tentativa de vários fármacos. Em 2015, após referenciação para consulta de neurologia, iniciou profilaxia com amitriptilina, tendo suspendido precocemente e abandonado o seguimento. Nos três anos seguintes teve consultas motivadas por doença aguda na unidade de saúde familiar, sem acompanhamento regular. Por persistência da enxaqueca recorreu ao serviço de urgência em jan/2018, onde foi referenciada novamente à consulta de neurologia, constatando-se automedicação com paracetamol + codeína, vinte supositórios em cada episódio de enxaqueca (com duração de três dias). Iniciou profilaxia com topiramato e agendou-se nova consulta. Suspendeu topiramato por emagrecimento e faltou à consulta. Recorreu à consulta da médica de família (MF) em jan/2019, referindo tristeza, insónia, obstipação e emagrecimento. Mantinha os episódios semanais de enxaqueca e o uso de supositórios. Após despiste de causa orgânica diagnosticou-se perturbação depressiva e CUEM. Explicou-se que o abuso medicamentoso poderia causar cefaleia e que o tratamento passaria pela cessação do fármaco. Foi medicada com antidepressivos e, nas consultas de reavaliação, constatou-se recuperação ponderal, melhoria do humor, cefaleia menos frequente e redução do uso de supositórios até à abstinência.  Comentário:  A CUEM desenvolve-se pelo uso excessivo de medicação para a cefaleia, sendo a suspensão da medicação o único tratamento eficaz. A doente manteve uma situação de abuso medicamentoso durante oito meses, tendo como consequência uma CUEM e correndo risco de toxicidade hepática. O MF é fulcral na deteção e abordagem precoce do abuso medicamentoso.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction:  Headache is a common complaint and self-medication is not uncommon. This article reports the approach to medication overuse headache (MOH) in a patient who self-medicated with analgesics, whose intervention was hampered by poor adherence to medical follow-up.  Case Description:  41-year-old woman, cleaning employee. History of migraine since adolescence, which worsened after her second delivery, presenting with weekly episodes without relief after several treatments were prescribed. In 2015, after referral to a Neurology consultation, she started prophylaxis with amitriptyline, which she suspended, missing the follow-up appointment. In the three years that followed, she only attended primary care consultations motivated by acute illness, without regular appointments. On Jan/2018, she went to the emergency department due to persistent migraine, and again she was referred to a Neurology consultation, where it was detected that she self-medicated with over twenty suppositories of paracetamol + codeine in each episode of migraine. Topiramate was prescribed and a new consultation was scheduled. She suspended topiramate due to weight loss and missed the follow-up appointment. On Jan/2020, she consulted her family doctor reporting sadness, insomnia, constipation, and weight loss. She maintained the migraine and the use of suppositories. After screening for organic causes, she was diagnosed with depressive disorder and MOH. It was explained that drug abuse could cause headaches and treatment would involve the cessation of that medication. She was medicated with antidepressants, and, in the next consultations, weight recovery, improved mood, less frequent headache, and reduced suppository use until withdrawal were documented.  Comment:  MOH develops due to the excessive use of headache relievers, and the suspension of medication is the only effective treatment. This patient maintained a situation of medication overuse for eight months, resulting in MOH and risk of liver toxicity. The family doctor is crucial to early detecting and addressing drug abuse.]]></p></abstract>
<kwd-group>
<kwd lng="pt"><![CDATA[Cefaleia]]></kwd>
<kwd lng="pt"><![CDATA[Enxaqueca]]></kwd>
<kwd lng="pt"><![CDATA[Analgésicos]]></kwd>
<kwd lng="pt"><![CDATA[Abuso medicamentoso]]></kwd>
<kwd lng="pt"><![CDATA[Cefaleia por uso excessivo de medicamentos.]]></kwd>
<kwd lng="en"><![CDATA[Headache]]></kwd>
<kwd lng="en"><![CDATA[Migraine]]></kwd>
<kwd lng="en"><![CDATA[Analgesics]]></kwd>
<kwd lng="en"><![CDATA[Drug abuse]]></kwd>
<kwd lng="en"><![CDATA[Medication overuse headache.]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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<label>1</label><nlm-citation citation-type="book">
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</article>
