Possible Pharmacological Mechanisms of Chronic Abuse of Analgesics and Other Antimigraine Drugs. In: Diener H, Wilkinson M, editors. Drug-Induced Headache. Berlin: Springer Berlin Heidelberg; 1988. pp. 95-104. [DOI: 10.1007/978-3-642-73327-7_12]

Construction of a medication dependence questionnaire in headache patients (MDQ-H) validation of the French version

OBJECTIVES

To construct and validate a questionnaire measuring dependence on analgesics and on migraine attack treatments in headache patients.

METHOD

The items were obtained using the Diagnostic and Statistic Manual of Mental Disorders (4th ed.) (DSM-IV) diagnostic criteria for dependence. The construct validity of the scale was investigated by confirmatory analysis in a sample of 156 patients. Regression analysis was used to explore predictive validity.

RESULTS

The 21 items of the scale were grouped into seven first-order factors corresponding to seven dependence items described in the DSM-IV. There was a second-order factor that may be considered as a general dependence factor. The global questionnaire score predicted the number of units of treatment taken per week, the number of days of headache, the number of days medications were taken, and emotional distress. Patients with headache associated with chronic substance use had a significantly higher score (P < .000) than migraine and tension headache patients.

CONCLUSION

It is a practical and valid tool for measuring medication dependence, including the behavioral dimension of dependence, in patients with headache associated with chronic substance use. It can prevent patients and clinicians from only focusing on pharmacological dependence.

Opiate and opioid use in patients with refractory headache

Opiate and opioid analgesics are commonly used for pain in general and presumably for headache. Codeine, oxycodone and propoxyphene, among the most commonly prescribed, do carry some risk of abuse, and their efficacy in headache patients has not been well studied. In many patients with other kinds of pain, however, both of neoplastic and non-neoplastic origin, chronic opiate use has been demonstrated to be of benefit without adverse side effects. The type of headache patient with intractable pain who needs frequent opiate analgesic and who does not develop addiction or drug abuse is an important subject for research.