Detoxification in a structured programme is effective for medication-overuse headache

2012 ◽  
Vol 3 (3) ◽  
pp. 198
Author(s):  
Signe Bruun Munksgaard ◽  
Lars Bendtsen ◽  
Rigmor Højland Jensen
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Educational Programme ◽  
Headache Frequency ◽  
Treatment Resistant ◽  
Headache Centre ◽  
Symptomatic Medication ◽  
Multidisciplinary Education ◽  
One Year

AbstractAimTo evaluate the long-term efficacy of two different treatment programmes for medication-overuse headache (MOH) in so-called treatment-resistant patients.MethodsMOH patients, who had previously been unsuccessfully treated by neurologists, were enrolled in one of 2 structured detoxification programmes in a tertiary headache centre: (A) a one-week withdrawal with restricted analgesics, rescue medications and prophylactics from Day 1 followed by advice of restricted intake of symptomatic medications or (B) a 2-month drug-free period and multidisciplinary education in groups and subsequent initiation of restricted symptomatic medication and prophylactics as required. All patients were closely followed up for a year.Results86 of 98 patients completed the 12-month follow-up. Totally, headache frequency was reduced by 39% (p <0.001), medication use by 63% (p <0.001) and 83% remained cured of MOH. Headache frequency was reduced with more than 50% in 42 patients (49%) and 52 (61%) reverted to episodic headache, and with no difference between the groups. Patients in programme B used significantly less symptomatic medication: 6.5 days/4 weeks compared with 8.7 days/4 weeks in programme A (p = 0.02), and the 56% of patients in programme B who needed prophylactic medication was significantly less than the 80% in programme A (p = 0.02). Further, programme B required fewer resources from the staff.ConclusionStructured detoxification with close follow-up by a multidisciplinary team for one year is highly effective in patients with previously treatment-resistant MOH. We recommend a multidisciplinary educational programme for patients in groups due to cost-effectiveness and limited use of medication.

Risk factors in medication-overuse headache: A 1-year follow-up study (care II protocol)

Cephalalgia ◽  
2009 ◽  
Vol 30 (3) ◽  
pp. 329-336 ◽  
Author(s):  
G Sances ◽  
N Ghiotto ◽  
F Galli ◽  
E Guaschino ◽  
C Rezzani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Treatment Strategies ◽  
Primary Headache ◽  
Headache Centre ◽  
Chi Squared ◽  
One Year ◽  
Predictor Factors

To investigate factors influencing prognosis in medication-overuse headache (MOH), we conducted a 12-month follow-up of patients with probable MOH. We recruited 215 patients consecutively admitted to our headache centre for an inpatient detoxification treatment. We analysed likely predictor factors for headache resolution (sex, age, primary headache, psychiatric comorbidity, type and timing of overuse). Mann–Whitney U-test and chi-squared test were used. One year after withdrawal, we had complete data on 172 patients (80%): 38 of these patients (22%) had relapsed into overuse and 134 (78%) had not. The negative prognostic factors for relapse were: intake of more than 30 doses/month ( P = 0.004), smoking ( P = 0.012), alcohol consumption ( P = 0.037), non-confirmation of MOH diagnosis 2 months after detoxification ( P = 0.000), and return to overused drug(s) ( P = 0.000). The 1-year relapse rate was 22%. The existence of sub-groups of MOH patients with such risk factors could influence treatment strategies.

Discontinuation of Medication Overuse in Headache Patients: Recovery of Therapeutic Responsiveness

Cephalalgia ◽  
2006 ◽  
Vol 26 (10) ◽  
pp. 1192-1198 ◽  
Author(s):  
P Zeeberg ◽  
J Olesen ◽  
R Jensen
Keyword(s):  
Drug Withdrawal ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Headache Frequency ◽  
Female Ratio ◽  
Headache Centre ◽  
Before And After ◽  
Male Female Ratio ◽  
Few Data ◽  
Almost All

It is generally accepted that ongoing medication overuse nullifies the effect of prophylactic treatment, although few data support this contention. We set out to describe the treatment outcome in patients withdrawn from medication overuse and relate any improvement to a renewed effect of prophylaxis. For patients with probable medication-overuse headache (pMOH), treated and dismissed from the Danish Headache Centre in 2002 and 2003, we assed, from prospective headache diaries, the headache frequency before and after withdrawal of offending drugs and compared these frequencies with the headache frequency at dismissal. Among 1326 patients, 337 had pMOH. Eligible were 175, mean age 49 years, male/female ratio 1: 2.7. Overall, there was a 46% decrease in headache frequency from the first visit to dismissal ( P < 0.0001). Patients with no improvement 2 months after complete drug withdrawal ( N = 88) subsequently responded to pharmacological and/or non-pharmacological prophylaxis with a 26% decrease in headache frequency as measured from the end of withdrawal to dismissal ( P < 0.0001). At dismissal, 47% were on prophylaxis. Former non-responders to medical prophylaxis had a 49% decrease in headache frequency from first visit to dismissal ( P < 0.0001), whereas those who had never received prophylaxis had a 56% reduction ( P < 0.0001). This difference was not statistically significant ( P = 0.22). Almost all MOH patients benefit from drug withdrawal, either just from the withdrawal or by transformation from therapeutic non-responsiveness to responsiveness. According to the International Classification of Headache Disorders, 2nd edn, the MOH diagnosis requires improvement after drug withdrawal. Our data suggest that these diagnostic criteria are too strict.

Long-term predictors of remission in patients treated for medication-overuse headache at a specialized headache center: A prospective cohort study

Cephalalgia ◽  
2016 ◽  
Vol 38 (2) ◽  
pp. 265-273 ◽  
Author(s):  
Jasna J Zidverc-Trajkovic ◽  
Tatjana Pekmezovic ◽  
Zagorka Jovanovic ◽  
Aleksandra Pavlovic ◽  
Milija Mijajlovic ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Predictive Values ◽  
One Year ◽  
The One

Objective To evaluate long-term predictors of remission in patients with medication-overuse headache (MOH) by prospective cohort study. Background Knowledge regarding long-term predictors of MOH outcome is limited. Methods Two hundred and forty MOH patients recruited from 2000 to 2005 were included in a one-year follow-up study and then subsequently followed until 31 December 2013. The median follow-up was three years (interquartile range, three years). Predictive values of selected variables were assessed by the Cox proportional hazard regression model. Results At the end of follow-up, 102 (42.5%) patients were in remission. The most important predictors of remission were lower number of headache days per month before the one-year follow-up (HR-hazard ratio = 0.936, 95% confidence interval (CI) 0.884–0.990, p = 0.021) and efficient initial drug withdrawal (HR = 0.136, 95% CI 0.042–0.444, p = 0.001). Refractory MOH was observed in seven (2.9%) and MOH relapse in 131 patients (54.6%). Conclusions Outcome at the one-year follow-up is a reliable predictor of MOH long-term remission.

Risk factors in medication overuse headache: A one-year follow-up study

2010 ◽  
pp. 68-72 ◽  
Author(s):  
Natascia Ghiotto ◽  
Grazia Sances ◽  
Federica Galli ◽  
Cristina Tassorelli ◽  
Elena Guaschino ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Follow Up Study ◽  
One Year

Medication overuse headache

Neurology ◽  
2017 ◽  
Vol 89 (12) ◽  
pp. 1296-1304 ◽  
Author(s):  
Ann I. Scher ◽  
Paul B. Rizzoli ◽  
Elizabeth W. Loder
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Secondary Headache ◽  
Headache Frequency ◽  
Drug Induced ◽  
Strong Basis ◽  
Medication Withdrawal ◽  
Symptomatic Medication ◽  
Treatment Limitation ◽  
Drug Induced Headache

It is a widely accepted idea that medications taken to relieve acute headache pain can paradoxically worsen headache if used too often. This type of secondary headache is referred to as medication overuse headache (MOH); previously used terms include rebound headache and drug-induced headache. In the absence of consensus about the duration of use, amount, and type of medication needed to cause MOH, the default position is conservative. A common recommendation is to limit treatment to no more than 10 or 15 days per month (depending on medication type) to prevent headache frequency progression. Medication withdrawal is often recommended as a first step in treatment of patients with very frequent headaches. Existing evidence, however, does not provide a strong basis for such causal claims about the relationship between medication use and frequent headache. Observational studies linking treatment patterns with headache frequency are by their nature confounded by indication. Medication withdrawal studies have mostly been uncontrolled and often have high dropout rates. Evaluation of this evidence suggests that only a minority of patients required to limit the use of symptomatic medication may benefit from treatment limitation. Similarly, only a minority of patients deemed to be overusing medications may benefit from withdrawal. These findings raise serious questions about the value of withholding or withdrawing symptom-relieving medications from people with frequent headaches solely to prevent or treat MOH. The benefits of doing so are smaller, and the harms larger, than currently recognized. The concept of MOH should be viewed with more skepticism. Until the evidence is better, we should avoid dogmatism about the use of symptomatic medication. Frequent use of symptom-relieving headache medications should be viewed more neutrally, as an indicator of poorly controlled headaches, and not invariably a cause.

Psychological factors associated with failure of detoxification treatment in chronic headache associated with medication overuse

Cephalalgia ◽  
2016 ◽  
Vol 36 (14) ◽  
pp. 1356-1365 ◽  
Author(s):  
S Bottiroli ◽  
M Viana ◽  
G Sances ◽  
N Ghiotto ◽  
E Guaschino ◽  
...  
Keyword(s):  
Psychological Factors ◽  
Minnesota Multiphasic Personality Inventory ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Treatment Strategies ◽  
Headache Frequency ◽  
Factors Associated ◽  
Frequency Group ◽  
Group B

Aim The aim of this study was to evaluate the psychological factors associated with a negative outcome following detoxification in a 2-month follow-up in medication-overuse headache. Methods All consecutive patients entering the detoxification program were analysed in a prospective, non-randomised fashion. Psychiatric conditions and personality characteristics were assessed using the Structured Clinical Interview for DSM-IV Disorders (SCID-I) and the Minnesota Multiphasic Personality Inventory (MMPI)-2. χ2 tests, one-way analyses of variance, and odds ratios (ORs) were used. Results A total of 248 patients completed the follow-up: 156 stopped overuse and their headaches reverted to an episodic pattern (Group A); 23 kept overusing without any benefit on headache frequency (Group B); and 51 stopped overuse without any benefit on headache frequency (Group C). The prognostic factors for the outcome of Group B were higher scores on the correction (OR 1.128; p = 0.036), depression (OR 1.071; p = 0.05), hysteria (OR 1.106; p = 0.023), and overcontrolled hostility (OR 1.182; p = 0.04) MMPI-2 scales, whereas those for Group C were psychiatric comorbidities (OR 1.502; p = 0.021) and higher scores on the hysteria scale (OR 1.125; p = 0.004). Conclusions The outcome of detoxification is influenced by psychological factors that should be considered when considering treatment strategies.

Combined Pharmacological and Short-Term Psychodynamic Psychotherapy for Probable Medication Overuse Headache: A Pilot Study

Cephalalgia ◽  
2009 ◽  
Vol 29 (3) ◽  
pp. 293-299 ◽  
Author(s):  
M Altieri ◽  
R Di Giambattista ◽  
L Di Clemente ◽  
D Fagiolo ◽  
E Tarolla ◽  
...  
Keyword(s):  
Psychodynamic Psychotherapy ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Pharmacological Therapy ◽  
Headache Frequency ◽  
Short Term ◽  
Medication Intake ◽  
Group A ◽  
Group B

We studied the effects of short-term psychodynamic psychotherapy (STPP) and pharmacological therapy in 26 consecutive patients with probable medication overuse headache (pMOH). Patients underwent a standard in-patient detoxification protocol, lasting a mean of 7 days. Eleven patients overused non-steroidal anti-inflammatory drugs (NSAIDs), five a combination of NSAIDs and triptans, four triptans, four a combination of NSAIDs, and three triptans and ergot derivates. Preventive therapy was initiated during detoxification. The STPP protocol comprised the Brief Psychodynamic Investigation (BPI) and psychoanalysis-inspired psychotherapy. All patients (groups A and B) underwent the BPI and pharmacological therapy. Half of the patients (group B) also not randomly underwent psychoanalysis-inspired psychotherapy. We found a significant interaction between time and group for headache frequency and medication intake. At 12-month follow-up, a statistically greater decrease in headache frequency and medication intake was observed in group B than in group A ( P = 0.0108 and P = 0.0097, respectively). The relapse rate was much lower in group B patients at both 6 and 12 months [15.3%, odds ratio (OR) 0.11, P = 0.016, and 23%, OR 0.18, P = 0.047, respectively] than in group A. The risk of developing chronic migraine (CM) during follow-up was higher in group A than in group B at 6 (OR 2.0, P = 0.047) and 12 months (OR 2.75, P = 0.005). Our study suggests that STPP in conjunction with drug withdrawal and prophylactic pharmacotherapy relieves headache symptoms in pMOH, reducing both long-term relapses and the burden of CM.

Transformed Migraine and Medication Overuse in a Tertiary Headache Centre — Clinical Characteristics and Treatment Outcomes

Cephalalgia ◽  
2004 ◽  
Vol 24 (6) ◽  
pp. 483-490 ◽  
Author(s):  
ME Bigal ◽  
AM Rapoport ◽  
FD Sheftell ◽  
SJ Tepper ◽  
RB Lipton
Keyword(s):  
Medication Overuse ◽  
Transformed Migraine ◽  
Headache Centre ◽  
Daily Headache ◽  
Group 2 ◽  
Combination Analgesics ◽  
One Year ◽  
Ergotamine Tartrate ◽  
Group 1

Studies suggest that a substantial proportion of headache sufferers presenting to headache clinics may overuse acute medications. In some cases, overuse may be responsible for the development or maintenance of a chronic daily headache (CDH) syndrome. The objectives of this study are to evaluate patterns of analgesic overuse in patients consulting a headache centre and to compare the outcomes in a group of patients who discontinued medication overuse to those of a group who continued the overuse, in patients with similar age, sex and psychological profile. We reviewed charts of 456 patients with transformed migraine (TM) and acute medication overuse defined by one of the following criteria: 1. Simple analgesic use (> 1000 mg ASA/acetaminophen) > 5 days/week; 2. Combination analgesics use (caffeine and/or butalbital) > 3 tablets a day for > 3 days a week; 3. Opiate use > 1 tablet a day for > 2 days a week; 4. Ergotamine tartrate use: 1 mg PO or 0.5 mg PR for > 2 days a week. For triptans, we empirically considered overuse > 1 tablet per day for > 5 days per week. Patients who were able to undergo detoxification and did not overuse medication (based on the above definition) after one year of follow-up were considered to have successful detoxification (Group 1). Patients who were not able to discontinue offending agents, or returned to a pattern of medication overuse within one year were considered to have unsuccessful detoxification (Group 2). We compared the following outcomes after one year of follow-up: Number of days with headache per month; Intensity of headache; Duration of headache; Headache score (frequency x intensity). The majority of patients overused more than one type of medication. Numbers of tablets taken ranged from 1 to 30 each day (mean of 5.2). Forty-eight (10.5%) subjects took > 10 tablets per day. Considering patients seen in the last 5 years, we found the following overused substances: Butalbital containing combination products, 48%; Acetaminophen, 46.2%; Opioids, 33.3%; ASA, 32.0%; Ergotamine tartrate, 11.8%; Sumatriptan, 10.7%; Nonsteroidal anti-inflammatory medications other than ASA, 9.8%; Zolmitriptan, 4.6%; Rizatriptan, 1.9%; Naratriptan, 0.6%. Total of all triptans, 17.8%. Of 456 patients, 318 (69.7%) were successfully detoxified (Group 1), and 138 (30.3%) were not (Group 2). The comparison between groups 1 and 2 after one year of follow-up showed a decrease in the frequency of headache of 73.7% in group 1 and only 17.2% in group 2 ( P < 0.0001). Similarly, the duration of head pain was reduced by 61.2% in group 1 and 14.8% in group 2 ( P < 0.0001). The headache score after one year was 18.8 in group 1 and 54 in group 2 ( P < 0.0001). A total of 225 (70.7%) successfully detoxified subjects in Group 1 returned to an episodic pattern of migraine, compared to 21 (15.3%) in Group 2 ( P < 0.001). More rigorous prescribing guidelines for patients with frequent headaches are urgently needed. Successful detoxification is necessary to ensure improvement in the headache status when treating patients who overuse acute medications.

Outcome of Medication Overuse Headache after Abrupt in-Patient withdrawal

Cephalalgia ◽  
2006 ◽  
Vol 26 (5) ◽  
pp. 589-596 ◽  
Author(s):  
G Relja ◽  
A Granato ◽  
A Bratina ◽  
RM Antonello ◽  
M Zorzon
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Drug Intake ◽  
Patient Withdrawal ◽  
Abrupt Discontinuation ◽  
Medication Abuse ◽  
Daily Headache ◽  
Mean Time

One hundred and one patients suffering from chronic daily headache (CDH) and medication overuse were treated, in an in-patient setting, with abrupt discontinuation of the medication overused, intravenous hydrating, and intravenous administration of benzodiazepines and ademetionine. The mean time to CDH resolution was 8.8 days. The in-patient withdrawal protocol used was effective, safe and well tolerated. There was a trend for a shorter time to CDH resolution in patients who overused triptans ( P = 0.062). There was no correlation between time to CDH resolution and either the type of initial primary headache or duration of medication abuse, whereas time to CDH resolution was related to daily drug intake ( P = 0.01). In multiple regression analysis, daily drug intake, age and type of medication overused were independent predictors of time to CDH resolution. At 3-months' follow-up, no patient had relapsed and was again overusing symptomatic medications.

scholarly journals Diagnoses and other predictors of patient absenteeism in an outpatient neurology clinic

2018 ◽  
Vol 8 (4) ◽  
pp. 318-326
Author(s):  
David H. Do ◽  
James E. Siegler
Keyword(s):  
Logistic Regression ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Mixed Effects ◽  
Disease Rate ◽  
Charcot Marie Tooth Disease ◽  
Diagnostic Categories ◽  
Neurology Clinic ◽  
Independent Risk Factors

BackgroundWe sought to determine the neurologic diagnosis or diagnostic categories that are associated with a higher probability of honoring a scheduled follow-up visit in the outpatient clinic.MethodsWe conducted a retrospective analysis of patients evaluated over a 3-year period (July 2014–June 2017) at a single neurology clinic in an urban location. Adult patients who honored an initial scheduled outpatient appointment were included. Only diagnoses with a ≥0.5% prevalence at our center were analyzed. Mixed-effects logistic regression was used to determine association of independent variables and honored follow-up visits.ResultsOf 61,232 scheduled outpatient subsequent encounters for 20,729 unique patients, the overall absenteeism rate was 12.5% (95% confidence interval [CI] 12.2%–12.8%). Independent risk factors associated with absenteeism included younger age, black or Latino race/ethnicity, Medicaid/Medicare payor status, and longer delay from appointment scheduling to appointment date. In mixed-effects logistic regression, diagnoses associated with the lowest odds of showing were medication overuse headache (show rate 79.2%, odds ratio [OR] for honoring appointment 0.67, 95% CI 0.48–0.93) and depression (rate 85.9%, OR 0.82, 95% CI 0.70–0.97), whereas the diagnoses associated with the greatest odds of showing included Charcot-Marie-Tooth disease (rate 96.3%, OR 2.54, 95% CI 1.44–4.49) and aphasia (rate 95.9%, OR 2.34, 95% CI 1.28–4.30).ConclusionsCertain chronic neurologic diseases, such as medication overuse headache and depression, were associated with a significantly lower odds of honoring scheduled follow-up conditions. As these conditions influence quality of life and productivity, patients with these illnesses may benefit from selective targeting to encourage adherence with scheduled follow-up appointments.

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