scholarly journals Personality and Personality Disorders in Medication-Overuse Headache: A Controlled Study by SWAP-200

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Federica Galli ◽  
Annalisa Tanzilli ◽  
Alessandra Simonelli ◽  
Cristina Tassorelli ◽  
Grazia Sances ◽  
...  
Keyword(s):  
Psychological Functioning ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Treatment Strategies ◽  
Drug Misuse ◽  
Controlled Study ◽  
Assessment Procedure ◽  
Psychological Resources ◽  
Road Map ◽  
The Impact

Background. Medication-overuse headache (MOH) is a type of chronic headache, whose mechanisms are still unknown. The impact of psychological factors has been matter of debate from different perspectives. The role of personality and personality pathology in processes involved in MOH development has been advanced but was poorly studied. The hypothesis of addiction-like behaviors sustaining the drug misuse has been examined and reached contrasting findings. Objectives. This study is aimed at detecting personality and its disorders (PDs) in MOH, with a specific attention to the addiction aspect. Methods. Eighty-eight MOH patients have been compared with two clinical populations including 99 patients with substance use disorder (SUD) and 91 with PDs using the Shedler-Westen Assessment Procedure-200 (SWAP-200), a clinician-report tool that assesses both normal and pathological personality. MANCOVAs were performed to evaluate personality differences among MOH, SUD, and PD groups, controlling for age and gender. Results. MOH patients were predominantly women and older. They showed lower traits of the SWAP-200’s cluster A and B disorders than SUD and PD patients, who presented more severe levels of personality impairment. No differences in the SWAP-200’s cluster C have been found, indicating common personality features in these populations. At levels of specific PDs, MOH patients showed higher obsessive and dysphoric traits and better overall psychological functioning than SUD and PD patients. Conclusion. Although MOH, SUD, and PD populations have been evaluated in multiple sites with different levels of expertise, the study supported the presence of a specific constellation of personality in MOH patients including obsessive (perfectionist) and dysphoric characteristics, as well as good enough psychological resources. No similarities to drug-addicted and personality-disordered patients were found. Practitioners’ careful understanding of the personality characteristics of MOH patients may be useful to provide a road map for the implementation of more effective treatment strategies and intervention programs.

Treatment of medication-overuse headache: A systematic review

Cephalalgia ◽  
2015 ◽  
Vol 36 (4) ◽  
pp. 371-386 ◽  
Author(s):  
Chia-Chun Chiang ◽  
Todd J Schwedt ◽  
Shuu-Jiun Wang ◽  
David W Dodick
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Treatment Strategies ◽  
Preventive Treatment ◽  
Early Discontinuation ◽  
Level Of Evidence ◽  
Preventive Medication ◽  
Long Term Prognosis ◽  
Acute Headache

Introduction The objective of this review is to provide an evidence-based discussion of different treatment strategies for medication-overuse headache (MOH). Method We searched PubMed for articles discussing the treatment and prognosis of MOH published between 2004 and August 2014. Titles, abstract and articles were reviewed systematically. The level of evidence provided by each study of the included articles was determined according to the American Academy of Neurology Clinical practice guideline manual. We discuss the level of evidence to support the early discontinuation/withdrawal of overused medications, the level of evidence to support the use of preventive treatment, the short- and long-term prognosis, and the outcome according to the class of drug overused in patients diagnosed with MOH. Results The initial search resulted in 1313 articles; 68 articles met our inclusion criteria and were discussed. The level of evidence to support early discontinuation of overused medications alone is low due to the absence of controlled studies. Adding preventive medication to early discontinuation led to a better outcome than early discontinuation alone. For patients with chronic migraine (CM) and medication overuse (MO), there are large randomized control trials supporting the use of onabotulinumtoxinA and topiramate without early discontinuation of overuse; however, the evidence is limited since data were obtained from post hoc analysis. Conclusion Considering current available evidence and the systemic toxicity of overusing acute headache medication, we suggest discontinuation of the overused medication with the addition of preventive medication. Appropriately sized, randomized controlled trials evaluating the safety and long-term efficacy of preventive medication plus early discontinuation of overuse vs preventive medication alone vs early discontinuation of overuse alone are needed.

scholarly journals P.033 Eptinezumab reduced acute medication use in patients with chronic migraine and medication-overuse headache: subgroup analysis of Promise-2

2021 ◽  
Vol 48 (s3) ◽  
pp. S29-S29
Author(s):  
MJ Marmura ◽  
H Diener ◽  
J Hirman ◽  
R Cady ◽  
T Brevig ◽  
...  
Keyword(s):  
Chronic Migraine ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Baseline Period ◽  
Migraine Treatment ◽  
Medication History ◽  
Medication Class ◽  
The Us ◽  
Acute Headache ◽  
The Impact

Background: Eptinezumab is a preventive migraine treatment approved in the US. We evaluated the impact of eptinezumab on acute headache medication (AHM) use in patients diagnosed with chronic migraine (CM) and medication-overuse headache (MOH) in PROMISE-2. Methods: PROMISE-2 randomized patients with CM to eptinezumab 100mg, 300mg, or placebo for 2 intravenous doses administered every 12 weeks. Trained investigators diagnosed MOH at screening using 3-month medication history and ICHD-3b criteria. Endpoints included days/month of any AHM use (days of ≥1 medication class), total AHM use (summed days for each medication class), and triptan use over Weeks 1-12 and 13-24. AHM classes included triptan, ergot, opioid, simple analgesic, and combination analgesic. Results: Of 1072 PROMISE-2 patients, 431 (40.2%) were diagnosed with MOH (100mg, n=139; 300mg, n=147; placebo, n=145). During the 28-day baseline period, mean days of any AHM was ~16.4, total AHM was ~20.4, and triptan was ~8.9 across treatment arms. Over Weeks 1-12, mean days/month of any AHM was 8.8 (100mg), 9.9 (300mg), and 11.8 (placebo); total AHM was 10.8, 12.2, and 14.8; triptan was 4.3, 4.4, and 6.4. Similar or lower rates were observed over Weeks 13-24. Conclusions: In patients diagnosed with both CM and MOH, eptinezumab treatment reduced AHM use.

scholarly journals Evaluation of structural changes in orbitofrontal cortex in relation to medication overuse in migraine patients: a diffusion tensor imaging study

2021 ◽  
Vol 79 (6) ◽  
pp. 483-488
Author(s):  
Aygul Tantik Pak ◽  
Sebahat Nacar Dogan ◽  
Yildizhan Sengul
Keyword(s):  
Diffusion Tensor Imaging ◽  
Orbitofrontal Cortex ◽  
Structural Changes ◽  
Medication Overuse ◽  
Diffusion Tensor ◽  
Medication Overuse Headache ◽  
Treatment Strategies ◽  
Imaging Study ◽  
Primary Headaches ◽  
Significant Difference

Abstract Background: Migraine is a prevalent neurological disease that leads to severe headaches. Moreover, it is the commonest among the primary headaches that cause medication overuse headache (MOH). The orbitofrontal cortex (OFC) is one of the structures most associated with medication overuse. Objective: To determine microstructural changes in the OFC among migraine patients who developed MOH, through the diffusion tensor imaging (DTI) technique. Methods: Fifty-eight patients who had been diagnosed with migraine based on the Classification of Headache Disorders (ICHD-III-B) were included in the study. Patients were sub-classified into two groups, with and without MOH, based on the MOH criteria of ICHD-III-B. DTI was applied to each patient. The OFC fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values of the two groups were compared. Results: The mean age of all the patients was 35.98±7.92 years (range: 18-65), and 84.5% (n=49) of them were female. The two groups, with MOH (n=25) and without (n=33), were alike in terms of age, gender, family history, migraine with or without aura and duration of illness. It was found that there was a significant difference in FA values of the left OFC between the two groups (0.32±0.01 versus 0.29±0.01; p=0.04). Conclusions: An association was found between MOH and changes to OFC microstructure. Determination of neuropathology and factors associated with medication overuse among migraine patients is crucial in terms of identifying the at-risk patient population and improving proper treatment strategies specific to these patients.

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.

scholarly journals The impact of COVID-19 pandemic on headache symptoms and drug withdrawal among patients with medication overuse headache: a cross-sectional study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Changling Li ◽  
Yanbo Li ◽  
Mengmeng Ma ◽  
Yang Zhang ◽  
Jiajia Bao ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Drug Withdrawal ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
High Educational Level ◽  
Odds Ratios ◽  
Cross Sectional ◽  
Headache Intensity ◽  
Male Sex ◽  
The Impact

Abstract Background Coronavirus disease 2019 (COVID-19) bring about a range of psychological distress and symptom deterioration to headache patients especially to some migraineurs. Compared to migraineurs or normal control, medication overuse headache (MOH) patients are more likely to experience a worse psychological distress and poorer outcome in non-COVID-19 time. However, in COVID-19 pandemic, whether MOH patients would have greater physical and mental symptom deterioration or worse relief of headache symptoms and medications overuse remained unclear. We aim to investigate the impact of COVID-19 on MOH patients to guide for a better management in this study. Methods We enrolled MOH patients who were diagnosed and treated at headache clinic of West China Hospital. Information of the pre-pandemic 3 months period and COVID-19 pandemic period was collected. Univariate and multivariate logistic regression were performed to identify independent factors associated with changes in headache symptoms and drug withdrawal. Results Seventy-eight MOH patients were enrolled into the study ultimately. In comparison to pre-pandemic period, fewer MOH patients reported decreased headache days, intensity and days with acute medications per month during the pandemic. Available access to regular prophylactic medications was significantly associated with a reduction of at least 50% in headache days and decrease in headache intensity per month with respective odds ratios of 39.19 (95% CI 3.75–409.15, P = 0.002) and 10.13 (95% CI 2.33–44.12, P = 0.002). Following abrupt withdrawal and high educational level were both significant factors in decreasing headache intensity. Male sex was significantly associated with decrease in days with acute medication per month during the pandemic (odds ratios 4.78, 95%CI 1.44–15.87, P = 0.011). Conclusions Our findings reflect that MOH patients experienced a worse relief of headache symptoms and drug withdrawal during the pandemic. Available access to regular prophylactic medications was the significant independent factor for improvement of headache symptoms. Male sex was significantly associated with decreased days with acute medications per month.

Does Employee Recognition Affect Positive Psychological Functioning and Well-Being?

2015 ◽  
Vol 18 ◽  
Author(s):  
Mª Dolores Merino ◽  
Jesús Privado
Keyword(s):  
Psychological Functioning ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Well Being ◽  
Psychological Resources ◽  
Subjective Well Being ◽  
Employee Recognition ◽  
Positive Psychological Functioning ◽  
The Impact ◽  
The Relationship

AbstractEmployee recognition is one of the typical characteristics of healthy organizations. The majority of research on recognition has studied the consequences of this variable on workers. But few investigations have focused on understanding what mechanisms mediate between recognition and its consequences. This work aims to understand whether the relationship between employee recognition and well-being, psychological resources mediate. To answer this question a sample of 1831 workers was used. The variables measured were: employee recognition, subjective well-being and positive psychological functioning (PPF), which consists of 11 psychological resources. In the analysis of data, structural equation models were applied. The results confirmed our hypothesis and showed that PPF mediate the relationship between recognition and well-being. The effect of recognition over PPF is two times greater (.39) with peer-recognition than with supervisor-recognition (.20), and, the effect of PPF over well-being is .59. This study highlights the importance of promoting employee recognition policies in organizations for the impact it has, not only on well-being, but also on the positive psychological functioning of the workers.

scholarly journals EHMTI-0147. Medication overuse headache and alexithymia: a controlled study

2014 ◽  
Vol 15 (S1) ◽  
Author(s):  
G Sances ◽  
F Galli ◽  
M Caputi ◽  
E Guaschino ◽  
MG Cuzzoni ◽  
...  
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Controlled Study

scholarly journals Medication-overuse headache and opioid-induced hyperalgesia: A review of mechanisms, a neuroimmune hypothesis and a novel approach to treatment

Cephalalgia ◽  
2012 ◽  
Vol 33 (1) ◽  
pp. 52-64 ◽  
Author(s):  
Jacinta L Johnson ◽  
Mark R Hutchinson ◽  
Desmond B Williams ◽  
Paul Rolan
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Glial Activation ◽  
Novel Approach ◽  
Opioid Administration ◽  
Opioid Induced Hyperalgesia ◽  
Inflammatory State ◽  
Acute Headache

Introduction Patients with chronic headache who consume large amounts of analgesics are often encountered in clinical practice. Excessive intake of analgesics is now considered to be a cause, rather than simply a consequence, of frequent headaches, and as such the diagnosis “medication-overuse headache” (MOH) has been formulated. Despite the prevalence and clinical impact of MOH, the pathophysiology behind this disorder remains unclear and specific mechanism-based treatment options are lacking. Discussion Although most acute headache treatments have been alleged to cause MOH, here we conclude from the literature that opioids are a particularly problematic drug class consistently associated with worsening headache. MOH may not be a single entity, as each class of drug implicated may cause MOH via a different mechanism. Recent evidence indicates that chronic opioid administration may exacerbate pain in the long term by activating toll-like receptor-4 on glial cells, resulting in a pro-inflammatory state that manifests clinically as increased pain. Thus, from the available evidence it seems opioid-overuse headache is a phenomenon similar to opioid-induced hyperalgesia, which derives from a cumulative interaction between central sensitisation, due to repeated activation of nociceptive pathways by recurrent headaches, and pain facilitation due to glial activation. Conclusion Treatment strategies directed at inhibiting glial activation may be of benefit alongside medication withdrawal in the management of MOH.

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