scholarly journals Role of educational programs in management of patients with medication-overuse headache

2021 ◽  
Vol 13 (3) ◽  
pp. 27-33
Author(s):  
A. E. Shagbazyan ◽  
N. A. Kovalchuk ◽  
G. R. Tabeeva
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Fold Increase ◽  
Educational Programs ◽  
Primary Headaches ◽  
Effective Strategies ◽  
Group I ◽  
Headache Diary

Patients with primary headaches are prone to frequent uncontrolled use of analgesics, leading to medication-overuse headache (MOH). One of the most accessible and effective strategies for its prevention is informing patients about the potential danger of its development. For this, training programs («schools») are conducted.Objective: to evaluate the effectiveness of educational programs in management of patients with MOH and its prevention.Patients and methods. We included 120 patients (12 men and 108 women, mean age: men – 46.3±3.54 years, women – 41.3±9.5 years) with primary headache and MOH. The follow-up period was 12 months. First, patients were divided into two groups depending on the clinical diagnosis: group I (n=44) – patients with chronic primary headaches without MOH, group II (n=76) – patients with chronic primary headaches and MOH. Then, patients in each group were randomized into subgroups depending on the prescribed therapy. All participants underwent repeated clinical examinations and questionnaires assessment at 1-, 3- and 12-months follow-ups. In addition, all patients kept a headache diary. An educational «school» developed for this study was held in those subgroups where educational programs were specified.Results and discussion. We observed a significant decrease in mean Headache-Attributed Lost Time (HALT) and Headache Impact Test (HIT-6) scores (р<0,05) at 12-months follow-up in subgroups where headache educational programs were combined with drug therapy, compared to the subgroups without educational programs. At the end of follow-up, we found a mean 1.75-fold increase in patients' treatment satisfaction (compared to baseline) in the subgroups where the «school» was held. Financial costs during the 12-month follow-up period for patients decreased by seven times because most patients stopped taking medications to relieve headaches.Conclusion. Information and educational programs are an integral part of the management of patients with MOH.

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.

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.

Medication Overuse Headache: Clinical Features Predicting Treatment Outcome at 1-Year Follow-Up

Cephalalgia ◽  
2007 ◽  
Vol 27 (11) ◽  
pp. 1219-1225 ◽  
Author(s):  
J Zidverc-Trajkovic ◽  
T Pekmezovic ◽  
Z Jovanovic ◽  
A Pavlovic ◽  
M Mijajlovic ◽  
...  
Keyword(s):  
Chronic Headache ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Age At Onset ◽  
Primary Headache ◽  
Headache Disorder ◽  
Primary Headache Disorder ◽  
A Prospective Study ◽  
Predicting Treatment Outcome

We present a prospective study of 240 patients with medication overuse headache (MOH) treated with drug withdrawal and prophylactic medications. At 1-year follow-up, 137 (57.1%) patients were without chronic headache and without medication overuse, eight (3.3%) patients did not improve after withdrawal and 95 (39.6%) relapsed developing recurrent overuse. Age at time of MOH diagnosis, regular use of benzodiazepines, frequency and Migraine Disability Assessment (MIDAS) score of chronic headache, age at onset of primary headache, frequency and MIDAS score of primary headache, ergotamine compound overuse and daily drug intake were significantly different between successfully and unsuccessfully treated patients. Multivariate analysis determined the frequency of primary headache disorder, ergotamine overuse and disability of chronic headache estimated by MIDAS as independent predictors of treatment efficacy at 1-year follow-up.

scholarly journals Pain perception is altered in patients with medication-overuse headache but can improve after detoxification

2012 ◽  
Vol 3 (3) ◽  
pp. 198-198
Author(s):  
Signe Bruun Munksgaard ◽  
Lars Bendtsen ◽  
Rigmor Højland Jensen
Keyword(s):  
Healthy Volunteers ◽  
Central Sensitization ◽  
Pain Perception ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headaches ◽  
Pain Thresholds ◽  
Pressure Pain ◽  
Pressure Pain Thresholds

Abstract Background Previously, central sensitization has been found in chronic, primary headaches but pain perception in MOH patients has only scarcely been studied. Aim To investigate pain perception before and during detoxification in patients with medication overuse headache (MOH). Methods 35 patients with MOH following structured detoxification programmes were tested before and 2, 6 and 12 months after withdrawal and 40 age and sex matched, healthy volunteers were tested for comparison. We measured cephalic and extra cephalic pressure pain thresholds (PPT) and supra-threshold pressure pain (STPP) as well as extra cephalic pain thresholds, supra-threshold pain and wind-up for electrical stimulation. Results At baseline, cephalic and extra cephalic PPTs were significantly lower in patients with MOH compared with healthy volunteers. Cephalic STPP was significantly higher in MOH patients compared with healthy volunteers but decreased significantly from baseline to the 6-month and 12-month follow-up. Supra-threshold pain for a single electrical stimulus was significantly higher in MOH patients compared with healthy volunteers. In contrast to healthy volunteers, patients with MOH did not exhibit wind-up before withdrawal. After 2 months, MOH patients had regained ability to wind-up and this persisted at 6-month and 12-month follow-up. Conclusions Patients with MOH have altered pain sensation and exhibit both allodynia and hyperalgesia indicating central sensitization. Withdrawal from medication overuse causes significant decrease in central sensitization. The ability to wind-up is altered in MOH patients, probably as a consequence of medication overuse, but it can be regained after withdrawal. These findings emphasize the need for detoxification in MOH.

Detoxification in medication-overuse headache, a retrospective controlled follow-up study: Does care by a headache nurse lead to cure?

Cephalalgia ◽  
2015 ◽  
Vol 36 (2) ◽  
pp. 122-130 ◽  
Author(s):  
JA Pijpers ◽  
MA Louter ◽  
ME de Bruin ◽  
EW van Zwet ◽  
FG Zitman ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Outcome Measures ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Relative Reduction ◽  
Follow Up Study ◽  
Headache Diagnosis ◽  
Withdrawal Therapy

Aim J.A.P. and M.A.L. contributed equally to this manuscript. The aim of this article is to determine whether support by a headache nurse in the treatment of medication-overuse headache (MOH) increases successful withdrawal, and to study determinants of response to withdrawal therapy. Methods A retrospective, controlled follow-up study was performed with 416 MOH patients. All patients were treated with outpatient withdrawal therapy, with two treatment arms: with or without the support of a specialised headache nurse. The outcome measures were: i) successful withdrawal, defined as discontinuation of all headache medication according to the study protocol; and ii) the responder rate, defined as the percentage of patients with ≥50% reduction in headache days after successful withdrawal and iii) relative reduction in headache days after successful withdrawal. Results Successful withdrawal percentages were significantly higher in the group supported by the headache nurse than in the group without support (73.1% vs. 60.7%; p = 0.008), which was confirmed in multivariate analysis (OR 1.73, 95% CI 1.11–2.71, p = 0.016). Support by a headache nurse was not associated with response. The underlying primary headache diagnosis, determined after withdrawal, was significantly correlated with response. Conclusion The support by a headache nurse results in an increased adherence to detoxification.

scholarly journals Rates and Predictors of Relapse in Medication Overuse Headache: A Clinic-Based Study from China

2019 ◽  
Vol 82 (4-6) ◽  
pp. 68-74
Author(s):  
Huanxian Liu ◽  
Meichen Zhang ◽  
Xiaoyan Chen ◽  
Shuping Sun ◽  
Zhao Dong ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Risk Factor ◽  
Relapse Rate ◽  
Independent Risk Factor ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Education Levels

Objective: This study aims to further assess the rates and risk factors for relapse in medication overuse headache (MOH) patients in China. Methods: The patients were admitted to neurology outpatient clinics at Chinese PLA General Hospital (primarily for headache) and diagnosed with MOH. They responded well to 2 months of preventive treatment and completed a 1-year consultation. General information was collected, including demographic characteristics (age, height, weight, and education level), the clinical features of the headache and the use of pain relievers (type, frequency and duration). Differences in each factor between the group with relapse and the group without relapse were analyzed by the chi-square test or Wilcoxon test. Variables with a p < 0.05 were included as independent variables in nonconditional logistic regression analysis. Results: In total, 129 patients were recruited for this retrospective study. The relapse rate of the MOH patients at the 1-year follow-up was 24.8%. The relapse rate was significantly higher in the patients with migraine (29/97, 29.9%) than in the patients with tension-type headache (3/32, 9.4%) and in the patients with low education levels (middle school or lower; 24/77, 31.6%) than in those with high education levels (high school or higher; 8/52, 15.4%). Nonconditional logistic regression analysis showed that the type of primary headache was an independent risk factor for MOH relapse (OR 3.719, p = 0.044). Conclusions: The relapse rate of MOH patients at the 1-year follow-up was 24.8% in China. The type of primary headache is an independent risk factor for MOH relapse, and patients with migraine as the primary headache are more prone to relapse.

Medication Overuse Headache: Rates and Predictors for Relapse in a 4-year Prospective Study

Cephalalgia ◽  
2005 ◽  
Vol 25 (1) ◽  
pp. 12-15 ◽  
Author(s):  
Z Katsarava ◽  
M Muessig ◽  
A Dzagnidze ◽  
G Fritsche ◽  
HC Diener ◽  
...  
Keyword(s):  
Prospective Study ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Tension Type Headache ◽  
First Year ◽  
Follow Up Study ◽  
Type Headache

We present a prospective 4-year follow-up study of 96 patients with medication overuse headache following withdrawal. Complete datasets were available from 85 patients (89%) 6 months, from 79 patients (82%) 1 year and from 75 patients (78%) 4 years after withdrawal. Twenty-six patients (31%) relapsed within the first 6 months after withdrawal. The number of relapses increased to 32 (41%) 1 year and to 34 (45%) 4 years after withdrawal. The 4-year relapse rate was lower in migraine than in tension-type headache (32% vs. 91%, P ≤ 0.001) and combination of migraine and tension-type headache (32% vs. 70%, P ≤ 0.027) and also lower in patients overusing triptans than analgesics (21% vs. 71%, P ≤ 0.001). The study suggests that the majority of relapses occur within the first year after withdrawal and that the long-term success of withdrawal depends on the type of primary headache and the type of overused medication.

Case series of sixteen patients with nummular headache

Cephalalgia ◽  
2010 ◽  
Vol 30 (12) ◽  
pp. 1527-1530 ◽  
Author(s):  
Justin Moon ◽  
Kamran Ahmed ◽  
Ivan Garza
Keyword(s):  
Medication Overuse ◽  
Age Of Onset ◽  
Medication Overuse Headache ◽  
Case Series ◽  
Primary Headache ◽  
Headache Disorder ◽  
Therapeutic Interventions ◽  
Nummular Headache ◽  
Primary Headache Disorder ◽  
History Of

Introduction: Nummular headache is a rare primary headache disorder described by a focal circumscribed area of pain (2–6 cm in diameter). Literature on this disorder is sparse. Patients and methods: Here, we describe a case series of 16 patients (6 men, 10 women) seen at the Mayo Clinic. Results: Mean age of onset was 50 years (range, 19–79 years) and mean duration of headache was 7.9 years (range, 0.33–40 years). Location of headache varied and was found to be an average of 3.9 cm in diameter (range, 2–10 cm). Headache was episodic (<15 days/month) in four patients and chronic (>15 days/month) in 12 patients. Attention was paid to therapeutic interventions. Resolution was seen in 38% of patients. Migraine was present in the history of 56% of patients and medication overuse headache was found in 25%. Conclusions: Our series results support previous findings. In our population, no specific therapy was identified to be effective in more than one patient.

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.

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.

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