Factors associated with a negative outcome of medication-overuse headache: A 3-year follow-up (the ‘CARE’ protocol)

Aim To evaluate factors associated with a negative outcome in a 3-year follow-up of subjects diagnosed with medication-overuse headache (MOH) (revised-ICHD-II criteria). Methods All consecutive patients entering the center’s inpatient detoxification program were analyzed in a prospective, non-randomized fashion. All participants were assessed by a neurologist using an ad hoc patient record form. Personality was assessed using the Minnesota Multiphasic Personality Inventory (MMPI)-2, Chi-square test, one-way analysis of variance (ANOVA), and odds ratios (OR) were calculated as appropriate. Results One-hundred and fifty patients completed the follow-up (79.3% females, age 46.40 ± 11.31 years): 13 never stopped their drug overuse (A), 38 stopped their overuse, but relapsed at least once (B), and 99 stopped and never relapsed (C). The Group A patients differed from those in B + C as they were more frequently single (OR 0.134; p = 0.007) and unemployed (OR 3.273; p = 0.04), took a higher number of drug doses ( p < 0.001), and less frequently drank coffee (OR 3.273; p = 0.044). Personality profile: subjects in A scored higher than those in C on the following scales: Hypochondriasis ( p = 0.007), Depression ( p = 0.003), Paranoia ( p = 0.025), Fears ( p = 0.003), Obsessiveness ( p = 0.026), Bizarre Mentation ( p = 0.046), Social Discomfort ( p = 0.004), Negative Treatment Indicators ( p = 0.040), Repression ( p = 0.007), Overcontrolled Hostility ( p = 0.040), Addiction Admission ( p = 0.021), Social Responsibility ( p = 0.039), and Marital Distress ( p = 0.028). Conclusion Disease outcome in MOH patients is influenced negatively by overuse severity and by specific psychological and socio-economic variables. Other possible modifier factors were voluptuary habits.

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

Cephalalgia ◽

10.1177/0333102416631960 ◽

2016 ◽

Vol 36 (14) ◽

pp. 1356-1365 ◽

Cited By ~ 12

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.

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The “care” protocol: outcome of medication overuse headache in a three year follow-up study

The Journal of Headache and Pain ◽

10.1186/1129-2377-14-s1-p175 ◽

2013 ◽

Vol 14 (S1) ◽

Author(s):

G Sances ◽

N Ghiotto ◽

F Galli ◽

M Allena ◽

A Frustaci ◽

...

Keyword(s):

Medication Overuse ◽

Medication Overuse Headache ◽

Follow Up Study ◽

Care Protocol

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The “care” protocol: the role of personality in a three-year follow-up study of medication overuse headache

The Journal of Headache and Pain ◽

10.1186/1129-2377-14-s1-p174 ◽

2013 ◽

Vol 14 (S1) ◽

Author(s):

F Galli ◽

G Sances ◽

N Ghiotto ◽

A Frustaci ◽

E Guaschino ◽

...

Keyword(s):

Medication Overuse ◽

Medication Overuse Headache ◽

Follow Up Study ◽

Care Protocol

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The “care” protocol: the role of personality in a three-year follow-up study of medication overuse headache

The Journal of Headache and Pain ◽

10.1186/1129-2377-1-s1-p174 ◽

2013 ◽

Vol 1 (Suppl 1) ◽

pp. P174

Author(s):

F Galli ◽

G Sances ◽

N Ghiotto ◽

A Frustaci ◽

E Guaschino ◽

...

Keyword(s):

Medication Overuse ◽

Medication Overuse Headache ◽

Follow Up Study ◽

Care Protocol

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Follow up after burn injury is disturbingly low and linked with social factors

Journal of Burn Care & Research ◽

10.1093/jbcr/irab065 ◽

2021 ◽

Author(s):

Irina P Karashchuk ◽

Eve A Solomon ◽

David G Greenhalgh ◽

Soman Sen ◽

Tina L Palmieri ◽

...

Keyword(s):

Social History ◽

Drug Dependence ◽

Burn Injury ◽

Retrospective Chart Review ◽

Burn Patients ◽

Chi Square ◽

Factors Associated ◽

Ed Visits ◽

Zip Code

Abstract For medical and social reasons, it is important that burn patients attend follow up appointments (FUAs). Our goal was to examine the factors leading to missed FUAs in burn patients. A retrospective chart review was conducted of adult patients admitted to the burn center from 2016-2018. Data collected included burn characteristics, social history, and zip code. Data analysis was conducted using chi-square, Wilcox Rank Sum tests, and multivariate regression models. A total of 878 patients were analyzed, with 224 (25.5%) failing to attend any FUAs and 492 (56.0%) missing at least one appointment (MA). Patients who did not attend any FUAs had smaller burns (4.5 (8)% vs. 6.5 (11)% median (inter quartile range)), traveled farther (70.2 (111.8) vs. 52.5 (76.7) miles), and were more likely to be homeless (22.8% vs. 6.9%) and have drug dependence (47.3% vs. 27.2%). Patients who had at least one MA were younger (42 (26) vs. 46 (28) years) and more likely to be homeless (17.5% vs. 2.6%) and have drug dependence (42.5% vs. 19.4%). On multivariate analysis, factors associated with never attending a FUA were: distance from hospital (odds ratio (OR) 1.004), burn size (OR 0.96), and homelessness (OR 0.33). Factors associated with missing at least one FUA : age (OR 0.99), drug dependence (OR 0.46), homelessness (OR 0.22), and ED visits (OR 0.56). A high percentage of patients fail to make any appointment following their injury and/or have at least one MA. Both FUAs and MAs are influenced by social determinants of health.

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New Perspectives on Risk Factors for Non-fatal Strangulation and Post-assault Imaging

Journal of Interpersonal Violence ◽

10.1177/0886260520966673 ◽

2020 ◽

pp. 088626052096667

Author(s):

Grace B. McKee ◽

Kathy Gill-Hopple ◽

Daniel W. Oesterle ◽

Leah E. Daigle ◽

Amanda K. Gilmore

Keyword(s):

Sexual Assault ◽

Partner Violence ◽

Intimate Partner ◽

Chi Square ◽

Factors Associated ◽

Bodily Injury ◽

Weapon Use ◽

Chi Square Analysis ◽

Assault Characteristics

Strangulation has long been associated with death in the context of sexual assault and intimate partner violence (IPV). Non-fatal strangulation (NFS) during sexual assault, which refers to strangulation or choking that does not result in death, is common and has been associated with IPV and with bodily injury; however, other factors associated with NFS are unknown. The current study examined demographic and sexual assault characteristics associated with NFS among women who received a sexual assault medical forensic exam (SAMFE). A second purpose of this study was to explore factors associated with receiving follow-up imaging orders after NFS was identified during a SAMFE. Participants ( N = 882) ranged in age from 18 to 81 ( M = 28.85), with the majority identifying as non-Hispanic White (70.4%) or Black/African American (23.4%). A total of 75 women (8.5%) experienced NFS during the sexual assault. Of these, only 13 (17.3%) received follow-up imaging orders for relevant scans. Results from a logistic regression analysis demonstrated that NFS was positively associated with report of anal penetration, intimate partner perpetration, non-genital injury, and weapon use during the assault. Results from chi-square analysis showed that among sexual assaults involving women who experienced NFS, those whose assaults involved weapon use were over four times more likely to receive imaging orders compared to assaults without weapon use. These findings have implications for criminal justice, and if incorporated into danger assessments, could potentially reduce fatalities linked to sexual assault and/or IPV. Additional work is needed to ensure that all assaults with NFS trigger a referral for imaging regardless of other assault characteristics.

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Outcome of Medication Overuse Headache after Abrupt in-Patient withdrawal

Cephalalgia ◽

10.1111/j.1468-2982.2006.01073.x ◽

2006 ◽

Vol 26 (5) ◽

pp. 589-596 ◽

Cited By ~ 33

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.

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

Neurology Clinical Practice ◽

10.1212/cpj.0000000000000488 ◽

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

Cephalalgia ◽

10.1177/0333102416683918 ◽

2016 ◽

Vol 38 (2) ◽

pp. 265-273 ◽

Cited By ~ 9

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.

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