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Obermann M, Katsarava Z. Headache Attributed to a Substance or Its Withdrawal. Neurol Clin 2024; 42:497-506. [PMID: 38575262 DOI: 10.1016/j.ncl.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Identification of substances that may cause or trigger headache is important to start effective treatment early to prevent unnecessary suffering, deterioration in quality of life, and the development of chronic pain. Treatment in case of medication overuse and other chronic headache should be decisive and effective. Drug withdrawal and introduction of effective prophylactic medication for the underlying headache disorder should be the primary treatment strategy. Typical headache-inducing substances are nitric oxide, phosphodiesterase, cocaine, alcohol, histamine, carbon oxide, and calcitonin gene-related peptide. The withdrawal of caffeine, estrogen, and opioids is most often associated with the development of headache.
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Affiliation(s)
- Mark Obermann
- Department of Neurology, Hospital Weser-Egge, Brenkhaeuser Str. 71, Hoexter 37671, Germany; Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, Essen 45147, Germany.
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, Essen 45147, Germany; Evangelical Hospital Unna, Holbeinstr. 10, Unna 59423, Germany; EVEX Medical Corporation, 3 Vekua Street, Tiblisi, Republic of Georgia
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Kim C, Chomba M, Phiri A, Fwoloshi S, Claassen CW, Hachaambwa L, Saylor D. Primary headache disorders among people living with HIV in Lusaka, Zambia. J Neurol Sci 2024; 459:122976. [PMID: 38531241 DOI: 10.1016/j.jns.2024.122976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE We completed a cross-sectional survey study to determine headache prevalence and its association with HIV characteristics among people living with HIV (PLHIV) in Lusaka, Zambia. BACKGROUND Headaches are common but their association with HIV status is unknown. METHODS The HARDSHIP survey, a headache epidemiology questionnaire previously validated in Zambia, was distributed during a 3-month period to 3666 consecutive adult PLHIV attending routine clinic appointments at the Adult Infectious Diseases Centre at the University Teaching Hospital in Lusaka, Zambia. HIV disease characteristics were abstracted from their charts. RESULTS 1015 (27.7%) participants responded to the survey. Adjusted for age, 64% reported having a headache within the last year unrelated to another illness. Among participants, 201 met criteria for migraine (20%), 259 for tension-type headache (26%), 18 for probable medication-overuse headache (2%), and 121 for undetermined headache (12%). Prevalence for tension-type headache was significantly higher than that of migraine (P < 0.001). After adjusting for age and sex, higher CD4 counts were associated with migraine. No other associations were observed between overall headache or headache type with HIV disease characteristics including CD4 count, viral load, antiretroviral regimen, and time since HIV diagnosis. CONCLUSIONS Headaches are highly prevalent among this cohort of PLHIV in Zambia. Optimizing headache treatment and integrating it into routine HIV care may improve quality of life for a substantial proportion of PLHIV in Zambia.
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Affiliation(s)
- Curi Kim
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mashina Chomba
- Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia
| | - Arnold Phiri
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Sombo Fwoloshi
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Cassidy W Claassen
- Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Department of Medicine, University Teaching Hospital, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lottie Hachaambwa
- Department of Medicine, University of Zambia School of Medicine, Lusaka, Zambia; Department of Medicine, University Teaching Hospital, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deanna Saylor
- Department of Medicine, University Teaching Hospital, Lusaka, Zambia; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Koval'chuk NA, Shagbazian AE, Tabeeva GR. Abuse of medications for the treatment of migraines: results of an online survey. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.11.201146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background. The abuse of headache medications is an important factor in the formation of drug-induced headache.
Aim. To determine the prevalence and nature of drug use among patients with migraine and chronic cephalgic syndrome.
Materials and methods. An Internet survey was conducted among 1598 Internet users, as well as through social networks (Instagram, Facebook, VK) using Google Forms.
Results. 60% of respondents with chronic headache and migraine symptoms did not have a reliable diagnosis. More than 70% of patients choose a drug for pain relief on their own and 62.7% take the drug in every headache attack.
Conclusion. Among patients with chronic headaches and migraines, there is a high percentage of people abusing symptomatic drugs, which indicates a high risk of drug-induced headache formation.
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Freitas KDD, Alcantara RNM. Analgesic abuse headache: risk factors and causes of poor adherence in the detox process. HEADACHE MEDICINE 2021. [DOI: 10.48208/headachemed.2021.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BackgroundMedication overuse headache (MOH) is characterized by a pre-existing primary or secondary headache associated with medication overuse.AimsTo identify the clinical, epidemiological, and therapeutic profiles associated with MOH and poor adherence to treatment.MethodsA cross-sectional, comparative, descriptive, analytical study was carried out to assess the characteristics of patients with MOH treated at the Hospital Geral de Fortaleza (HGF).Results103 patients participated, 95 (92.2%) women and 8 (7.8%) men. Of these, 55 (53.4%) patients answered that had already been instructed about the MOH, however they continue to abuse medication for many reasons i.e.: difficulty in bearing pain, and fear of worsening the pain. When asked about what could be done to improve adherence to treatment, in a general way, 28 (27.2%) were unable to inform, 37 (35.9%) answered that most frequent consultations could help. Furthermore, 19 (18.4%) believe that psychological counseling wound bring benefits.ConclusionThe lack of guidance or interest in the guidelines provided are real and important obstacles to treat MOH. Changes in the care model that include effective communication, more frequent return, family and psychotherapy support and close monitoring by the physician or nurses are factors that should be considered in headache clinics.
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Novoa ME, Bordini CA. Higher frequency of medication overuse headache in patients attended by neurologists in Lima, Peru. HEADACHE MEDICINE 2021. [DOI: 10.48208/headachemed.2021.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BackgroundThe type of medical care received (self-medication and/or medical care provided by a general practitioner or a neurologist) may be associated with differences in the frequency of medication overuse headaches.MethodThis cross-sectional analytical study included 222 records of patients with chronic daily headaches seen at the National Institute of Neurological Sciences Outpatient Unit in Lima, Peru. A pre-designed questionnaire was used to assess and categorize patients with frequent and chronic headaches.ResultsNinety-four patients (42.34% of those with chronic daily headaches) met the criteria for medication overuse headache. Of these, 19 (28%) self-medicated, 22 (36%) consulted with the general practitioner, and the highest proportion of subjects, 53 (58%), consulted with a neurologist. On bivariate analysis, subjects who had received care from a general practitioner and self-medicated were 38% and 51% less likely to have MOH than the subjects whoreceived medical care from the neurologist (p=0.012; 95% CI 0.42-0.90 and p=0.001; 95% CI 0.32-0.74). On multivariate analysis adjusting by sociodemographic and clinical factors, the association remained significant in regards to self-medication, but became marginal (p=0.055) in regard to being seen by a general practitioner.ConclusionIn this study, the frequency of the headache due to overuse of medication was higher in patients attending a neurologist than those attending a general practitioner or self-medicated. This cross-sectional design cannot assess whether this reflects more severe cases looking for specialized care or more medication overuse headaches as a result of inappropriate management.
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Shnayder NA, Sharavii VB, Petrova MM, Moskaleva PV, Pozhilenkova EA, Kaskaeva DS, Tutynina OV, Popova TE, Garganeeva NP, Nasyrova RF. Candidate Genes and Proteomic Biomarkers of Serum and Urine in Medication-Overuse Headache. Int J Mol Sci 2021; 22:9024. [PMID: 34445731 PMCID: PMC8396559 DOI: 10.3390/ijms22169024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 01/03/2023] Open
Abstract
Chronic headache is a topical problem of neurology, psychiatry and general practice. The medication-overuse headache (MOH) is one of the leading pathologies in the structure of chronic headache. However, early diagnosis of the MOH is challenging. We analyzed potential proteomic biomarkers of serum and urine in patients with MOH. METHODS We searched PubMed, Springer, Scopus, Web of Science, ClinicalKey, and Google Scholar databases for English publications over the past 10 years using keywords and their combinations. RESULTS We found and analyzed seven studies that met the search criteria for the purpose of the review, including 24 serum proteomic biomarkers and 25 urine proteomic biomarkers of MOH. Moreover, the candidate genes and locus of the studied serum (vitamin D-binding protein, lipocalin-type prostaglandin D2 synthase, apolipoprotein E, etc.) and urine proteomic biomarkers (uromodulin, alpha-1-microglobulin, zinc-alpha-2-glycoprotein, etc.) of MOH are presented in this review. CONCLUSIONS The serum and urine proteomic biomarkers of MOH can potentially help with the identification of patients with MOH development. Due to the relevance of the problem, the authors believe that further investigation of the MOH proteomic biomarkers in different ethnic and racial groups of patients with primary headache is necessary. In addition, it is important to investigate whether medications of different drug classes influence the levels of serum and urine proteomic biomarkers.
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Affiliation(s)
- Natalia A. Shnayder
- The Center of Personalized Psychiatry and Neurology, V. M. Bekhterev National Medical Research Center for Neurology and Psychiatry, 192019 Saint-Petersburg, Russia;
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Victoria B. Sharavii
- The International School Medicine of the Future, I. M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Marina M. Petrova
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Polina V. Moskaleva
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Elena A. Pozhilenkova
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Darya S. Kaskaeva
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Olga. V. Tutynina
- The Center of Collective Usage “Molecular and Cell Technologies”, V. F. Voino-Yasenetsky Krasnoyarsk State Medical University, 660022 Krasnoyarsk, Russia; (M.M.P.); (P.V.M.); (E.A.P.); (D.S.K.); (O.V.T.)
| | - Tatiana E. Popova
- The Yakutsk Scientific Center for Complex Medicine Problems, The Department of Epidemiology of Non-Infectious Diseases, 677018 Yakutsk, Russia;
| | - Natalia P. Garganeeva
- The Department of General Medical Practice and Polyclinic Therapy, The Siberian State Medical University, 634050 Tomsk, Russia;
| | - Regina F. Nasyrova
- The Center of Personalized Psychiatry and Neurology, V. M. Bekhterev National Medical Research Center for Neurology and Psychiatry, 192019 Saint-Petersburg, Russia;
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Li C, Li Y, Ma M, Zhang Y, Bao J, Ge W, Liu Y, Peng C, He L. The impact of COVID-19 pandemic on headache symptoms and drug withdrawal among patients with medication overuse headache: a cross-sectional study. J Headache Pain 2021; 22:41. [PMID: 34020588 PMCID: PMC8139545 DOI: 10.1186/s10194-021-01256-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/10/2021] [Indexed: 02/08/2023] Open
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.
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Affiliation(s)
- Changling Li
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Yanbo Li
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Mengmeng Ma
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Yang Zhang
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Jiajia Bao
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Wenjing Ge
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Yanqin Liu
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Cheng Peng
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China
| | - Li He
- Department of Neurology, West China Hospital of Sichuan University, No. 37 Wainan Guoxue Xiang, Chengdu, 610041, China.
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Takahashi TT, Ornello R, Quatrosi G, Torrente A, Albanese M, Vigneri S, Guglielmetti M, Maria De Marco C, Dutordoir C, Colangeli E, Fuccaro M, Di Lenola D, Spuntarelli V, Pilati L, Di Marco S, Van Dycke A, Abdullahi RA, Maassen van den Brink A, Martelletti P. Medication overuse and drug addiction: a narrative review from addiction perspective. J Headache Pain 2021; 22:32. [PMID: 33910499 PMCID: PMC8080402 DOI: 10.1186/s10194-021-01224-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/12/2021] [Indexed: 12/27/2022] Open
Abstract
Chronic headache is particularly prevalent in migraineurs and it can progress to a condition known as medication overuse headache (MOH). MOH is a secondary headache caused by overuse of analgesics or other medications such as triptans to abort acute migraine attacks. The worsening of headache symptoms associated with medication overuse (MO) generally ameliorates following interruption of regular medication use, although the primary headache symptoms remain unaffected. MO patients may also develop certain behaviors such as ritualized drug administration, psychological drug attachment, and withdrawal symptoms that have been suggested to correlate with drug addiction. Although several reviews have been performed on this topic, to the authors best knowledge none of them have examined this topic from the addiction point of view. Therefore, we aimed to identify features in MO and drug addiction that may correlate. We initiate the review by introducing the classes of analgesics and medications that can cause MOH and those with high risk to produce MO. We further compare differences between sensitization resulting from MO and from drug addiction, the neuronal pathways that may be involved, and the genetic susceptibility that may overlap between the two conditions. Finally, ICHD recommendations to treat MOH will be provided herein.
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Affiliation(s)
- Tatiane Teru Takahashi
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 20 Newcomen St, London, SE1 1YR, UK. .,Present address: Medicines Discovery Catapult, Block 35, Mereside, Alderley Park, Cheshire, SK10 4TG, UK.
| | - Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Via Vetoio 1, Coppito, 67100, L'Aquila, Italy
| | - Giuseppe Quatrosi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90127, Palermo, Italy
| | - Angelo Torrente
- Department of Biomedicine, Neurosciences and Diagnostic (Bi.N.D.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Maria Albanese
- Department of Systems Medicine, University of Rome "Tor Vergata"; Neurology Unit, "Tor Vergata" Hospital, Viale Oxford, 81, 00133, Rome, Italy
| | - Simone Vigneri
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy.,Pain Medicine Unit, Santa Maria Maddalena Hospital, Occhiobello, Italy
| | - Martina Guglielmetti
- Regional Headache Referral Center, Sant'Andrea Hospital, Via di Grottarossa 1039, 00189, Rome, Italy.,Department of Medical, Surgical and Experimental Sciences, University of Sassari, Piazza Università, 21, 07100, Sassari, Italy
| | - Cristiano Maria De Marco
- Regional Headache Referral Center, Sant'Andrea Hospital, Via di Grottarossa 1039, 00189, Rome, Italy
| | - Camille Dutordoir
- Department of Neurology, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Enrico Colangeli
- Present address: Medicines Discovery Catapult, Block 35, Mereside, Alderley Park, Cheshire, SK10 4TG, UK
| | - Matteo Fuccaro
- Department of Neurology, Conegliano Hospital, Via Brigata Bisagno, 2, 31015, Conegliano, Italy
| | - Davide Di Lenola
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome, Polo Pontino, Viale XXIV Maggio 7, 04100, Latina, Italy
| | - Valerio Spuntarelli
- Division of Pharmacology, Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Wytemaweg 80, 3015, CN, Rotterdam, The Netherlands
| | - Laura Pilati
- Department of Biomedicine, Neurosciences and Diagnostic (Bi.N.D.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Salvatore Di Marco
- Department of Biomedicine, Neurosciences and Diagnostic (Bi.N.D.), University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Annelies Van Dycke
- Department of Neurology, AZ Sint-Jan Brugge, Ruddershove 10, 8000, Brugge, Belgium
| | - Ramla Abuukar Abdullahi
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 20 Newcomen St, London, SE1 1YR, UK.,Headache Centre, Guy's and St Thomas NHS Trust, London, UK
| | | | - Paolo Martelletti
- Regional Headache Referral Center, Sant'Andrea Hospital, Via di Grottarossa 1039, 00189, Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University of Rome, Via di Grottarossa 1039, 00189, Rome, Italy
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Lund I, Moan IS, Edvardsen HME. The relative impact of smoking, alcohol use and drug use on general sickness absence among Norwegian employees. BMC Public Health 2019; 19:500. [PMID: 31053139 PMCID: PMC6499980 DOI: 10.1186/s12889-019-6891-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well documented that tobacco, alcohol and drug use can be detrimental to health. However, little is known about the relative impact of these factors on sickness absence, and whether the association between use of these substances and sickness absence is different for women and men. The aim of this study was to examine the association between tobacco-, alcohol- and drug use, as well as polydrug use, and sickness absence among Norwegian employees. METHODS During 2011-2014, 1911 employees in Norway completed a questionnaire about their tobacco, alcohol and drug use habits, their total number of sickness absences during the last 12 months, and the length (no. of days) of their last sick leave. Samples of oral fluid were analysed for illegal and medicinal drugs. RESULTS Daily smoking and current use of medical drugs were significantly associated with sickness absence. Employees who were daily smokers also had an increased likelihood of having long and frequent sickness absence. Use of snus (Swedish moist snuff), binge drinking, current use of illegal drugs and polydrug use were not significantly associated with sickness absence. Women and young participants were more likely to report having had sickness absence the past 12 months. However, the associations between daily smoking and medical drug use and sickness absence, respectively, were only statistically significant for men. CONCLUSION According to this study, daily smoking and use of medical drugs are the substance use habits most closely associated with sickness absence. Implications for future research are discussed.
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Affiliation(s)
- Ingeborg Lund
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, PO Box 222, Skøyen, N-0213, Oslo, Norway.
| | - Inger Synnøve Moan
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, PO Box 222, Skøyen, N-0213, Oslo, Norway
| | - Hilde Marie Erøy Edvardsen
- Oslo University Hospital, Department of Forensic Sciences, Section of Drug Abuse Research, Kirkeveien 166, N-0450, Oslo, Norway
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Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, Toom K, Vandervorst F, Quintana S, Paemeleire K, Katsarava Z. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain 2018; 19:50. [PMID: 30003412 PMCID: PMC6043466 DOI: 10.1186/s10194-018-0875-x] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/13/2018] [Indexed: 12/30/2022] Open
Abstract
Medication overuse in primary headache disorders is a worldwide phenomenon and has a role in the chronification of headache disorders. The burden of disease on individuals and societies is significant due to high costs and comorbidities. In the Third Edition of the International Classification of Headache Disorders, medication-overuse headache is recognized as a separate secondary entity next to mostly primary headache disorders, although many clinicians see the disease as a sole complication of primary headache disorders. In this review, we explore the historical background of medication-overuse headache, its epidemiology, phenomenology, pathophysiology and treatment options. The review explores relevant unanswered questions and summarizes the current debates in medication-overuse headache.
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Affiliation(s)
- Nicolas Vandenbussche
- Headache Group, Department of Basic and Clinical Neuroscience, King’s College London, and NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College Hospital, Denmark Hill, London, SE5 9PJ UK
| | - Domenico Laterza
- Department of Neuroscience, St. Agostino Estense Hospital, University of Modena and Reggio Emilia, via P. Giardini 1355, 41100 Modena, Italy
| | - Marco Lisicki
- Headache Research Unit, Université de Liège, Liège, Belgium
| | - Joseph Lloyd
- Headache Research-Wolfson CARD, King’s College London, London, UK
| | - Chiara Lupi
- Headache Centre, Careggi University Hospital, Health Sciences Department, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Hannes Tischler
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Kati Toom
- Department of Neurology, Tartu University Clinics, Tartu, Estonia
- Estonian Headache Society, Tartu, Estonia
| | | | - Simone Quintana
- Headache Center, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Zaza Katsarava
- Evangelical Hospital Unna and University of Duisburg-Essen, Duisburg, Germany
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Diener HC, Holle D, Dresler T, Gaul C. Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:365-370. [PMID: 29932046 PMCID: PMC6039717 DOI: 10.3238/arztebl.2018.0365] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 10/30/2017] [Accepted: 03/15/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND The frequent or regular use of analgesics and anti-migraine drugs can make headache more frequent and induce the transformation of episodic to chronic headache. Chronic headache due to medication overuse is defined as headache that is present on ≥ 15 days per month for at least three months in a patient who previously suffered from primary headaches, and who takes analgesics on ≥ 15 days per month or anti-migraine drugs (triptans or ergot alkaloids), opioid drugs, or combined analgesics on ≥ 10 days per month. METHODS This review is based on pertinent articles published up to December 2017 that were retrieved by a selective search in PubMed employing the terms "medication overuse AND headache" and "medication overuse headache." RESULTS The prevalence of medication overuse headache in the general population in Germany is 0.7% -1%. This disorder is more common in women and in persons suffering from comorbid mental disorders or other painful conditions. The treatment of medication overuse headache consists of three steps. Patient education and counseling are given with the goal of reducing the intake of medication for acute headache treatment. The ensuing headache prophylaxis is with topiramate, amitriptyline, or onabotulinum toxin A. If these treatment strategies fail, a drug holiday is recommended. This can be in the outpatient, day clinic, or inpatient setting, depending on the severity of the condition and its comorbidities. CONCLUSION Patients who frequently take acute medication to treat headache episodes must be identified early in order to avoid headache chronification and medication overuse headache. The suggested treatment algorithm is still in need of validation by randomized trials.
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Affiliation(s)
| | - Dagny Holle
- Department of Neurology and West German Headache Center, Essen
| | - Thomas Dresler
- Department of Psychiatry and Psychotherapy, University Hospital and Faculty of Medicine, Tübingen LEAD Graduate School & Research Network, University of Tübingen
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Hedenrud T, Andersson Sundell K, Martinsson J, Håkonsen H. Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: a population-based study. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:17-24. [PMID: 29687513 DOI: 10.1111/ijpp.12457] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 03/22/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To analyse attitudes towards sales and use of over-the-counter (OTC) drugs in the Swedish adult population. METHODS Data were collected through the web-based Citizen Panel comprising 21 000 Swedes. A stratified sample of 4058 participants was emailed a survey invitation. Questions concerned use of OTC drugs, and attitudes towards sales and use of OTC drugs. Correlations between the attitudinal statements were assessed using Spearman's rank correlation. Associations between attitudes and participant characteristics were analysed using multinomial logistic regression. KEY FINDINGS Participation rate was 64%. Altogether 87% reported use of OTC drugs in the last 6 months. Approximately 10% of participants stated that they used OTC drugs at the first sign of illness, and 9% stated that they used more OTC drugs compared with previously, due to increased availability. The statement on use of OTC drugs at first sign of illness correlated with the statement about using more OTC drugs with increased availability. Socio-demographic factors (age, sex and education) and frequent use of OTC drugs were associated with attitudes to sales and use of OTC drugs. CONCLUSIONS Increased use due to greater availability, in combination with OTC drug use at first sign of illness illustrates the need for continuous education of the population about self-care with OTC drugs. Increased awareness of the incautious views on OTC drugs in part of the population is important. Swedish policy-makers may use such knowledge in their continuous evaluation of the 2009 pharmacy reform to review the impact of sales of OTC drugs in retail outlets on patient safety and public health. Pharmacy and healthcare staff could be more proactive in asking customers and patients about their use of OTC drugs and offering them advice.
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Affiliation(s)
- Tove Hedenrud
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - Johan Martinsson
- Department of Political Science, University of Gothenburg, Gothenburg, Sweden
| | - Helle Håkonsen
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
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Corbelli I, Sarchielli P, Eusebi P, Cupini LM, Caproni S, Calabresi P. Early management of patients with medication-overuse headache: results from a multicentre clinical study. Eur J Neurol 2018; 25:1027-1033. [PMID: 29575668 DOI: 10.1111/ene.13632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/28/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Educational intervention has proved to be effective in reducing drug abuse in uncomplicated medication-overuse headache (MOH). This ancillary of the SAMOHA multicentre study aimed to assess any differences in phenotypic characteristics, type and amount of drugs overused, and comorbidities between patients with MOH who responded to simple advice and those who did not. METHODS Demographic and clinical headache data of the last 3 months before enrollment of patients were collected and patients were then asked to fill out a daily headache diary for 4 weeks. Patients were then divided into two subgroups, i.e. those with confirmed MOH continued in the study [randomized (R) group], whereas those who did not still show any features of MOH dropped out of the study. RESULTS A total of 88 (67.7%) patients still met the inclusion criteria after the baseline 4 weeks (R group). Conversely, 42 (32.3%) patients dropped out of the study. A detailed analysis of those who dropped out revealed that only 34 were not randomized at visit 2 because they no longer satisfied the inclusion criteria for MOH [screening failures (SF) group]. The SF group was significantly younger and had fewer years of migraine history than the R group. Moreover, the SF group had a significantly shorter history of chronicity compared with the R group. CONCLUSIONS Our findings suggest that in MOH trials, after an educational session, an observational period is needed in order to confirm the diagnosis of MOH and to avoid overestimation of the effect of other treatments used to manage MOH. Future research should focus mainly on those patients with MOH who do not respond to simple advice and with unsuccessful withdrawal.
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Affiliation(s)
- I Corbelli
- Dipartimento di Medicina, Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - P Sarchielli
- Dipartimento di Medicina, Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - P Eusebi
- Dipartimento di Medicina, Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy
| | - L M Cupini
- Centro Cefalee e Malattie Cerebrovascolari, Ospedale S. Eugenio, Roma, Italy
| | - S Caproni
- S.C. Neurologia, Dipartimento di Neuroscienze, Azienda Ospedaliero - Universitaria di Terni, Terni, Italy
| | - P Calabresi
- Dipartimento di Medicina, Clinica Neurologica, Azienda Ospedaliero - Universitaria di Perugia, Perugia, Italy.,IRCCS Fondazione 'S. Lucia', Roma, Italy
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14
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Zidverc-Trajkovic JJ, Pekmezovic T, Jovanovic Z, Pavlovic A, Mijajlovic M, Radojicic A, Sternic N. Long-term predictors of remission in patients treated for medication-overuse headache at a specialized headache center: A prospective cohort study. Cephalalgia 2016; 38:265-273. [PMID: 27940881 DOI: 10.1177/0333102416683918] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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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Affiliation(s)
- Jasna J Zidverc-Trajkovic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Tatjana Pekmezovic
- 2 Faculty of Medicine, University of Belgrade, Serbia.,3 Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Zagorka Jovanovic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Pavlovic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Milija Mijajlovic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Radojicic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Nadezda Sternic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
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16
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Find NL, Terlizzi R, Munksgaard SB, Bendtsen L, Tassorelli C, Nappi G, Katsarava Z, Lainez M, Goicochea MT, Shand B, Fadic R, Spadafora S, Pagani M, Jensen R. Medication overuse headache in Europe and Latin America: general demographic and clinical characteristics, referral pathways and national distribution of painkillers in a descriptive, multinational, multicenter study. J Headache Pain 2016; 17:20. [PMID: 26957090 PMCID: PMC4783306 DOI: 10.1186/s10194-016-0612-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/26/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication overuse headache (MOH) is a very disabling and costly disorder due to indirect costs, medication and healthcare utilization. The aim of the study was to describe general demographic and clinical characteristics of MOH, along with the national referral pathways and national painkillers distribution in several European and Latin American (LA) Countries. METHODS This descriptive cross-sectional observational study included 669 patients with MOH referred to headache-centers in Europe and LA as a part of the COMOESTAS project. Information about acute medication and healthcare utilization were collected by extensive questionnaires, supplemented with structured patient interviews. RESULTS Triptans were overused by 31 % European patients and by 6 % in LA (p < 0.001), whereas ergotamines were overused by 4 % in Europe and 72 % in LA (p < 0.001). Simple analgesics were overused by 54 % in Europe and by 33 % in LA (p < 0.001), while combination-analgesics were more equally overused (24 % in Europe and 29 % in LA). More European patients (57 %) compared with LA patients (27 %) visited general practitioners (p < 0.001), and 83 % of European patients compared to 38 % in LA consulted headache specialists (p < 0.001). A total of 20 % in Europe and 30 % in LA visited emergency rooms (p = 0.007). CONCLUSION There are marked variations between LA and Europe in healthcare pathways and in acute medication overuse regarding patients with MOH. This should be considered when planning prevention campaigns against MOH.
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Affiliation(s)
- Ninett Louise Find
- Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark
- Danish Headache Center, Neurological Department, Glostrup Hospital, Glostrup, Denmark
| | - Rossana Terlizzi
- Danish Headache Center, Neurological Department, Glostrup Hospital, Glostrup, Denmark
- Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum, Bologna University, Ospedale Bellaria, Bologna, Italy
| | | | - Lars Bendtsen
- Danish Headache Center, Neurological Department, Glostrup Hospital, Glostrup, Denmark
| | - Cristina Tassorelli
- Headache Science Center, C. Mondino National Neurological Institute C. Mondino Foundation, Dept. of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giuseppe Nappi
- Headache Science Center, C. Mondino National Neurological Institute C. Mondino Foundation, Dept. of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Zaza Katsarava
- Department of Neurology, University Hospital of Essen, Essen, Germany
| | - Miguel Lainez
- Foundation of the Valencian Community, University Clinical Hospital, Barcelona, Spain
| | | | - Beatriz Shand
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ricardo Fadic
- Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Marco Pagani
- Bioengineering and Medical Informatics Consortium, Pavia, Italy
| | - Rigmor Jensen
- Danish Headache Center, Neurological Department, Glostrup Hospital, Glostrup, Denmark.
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Shand B, Goicochea MT, Valenzuela R, Fadic R, Jensen R, Tassorelli C, Nappi G. Clinical and Demographical Characteristics of Patients with Medication Overuse Headache in Argentina and Chile: Analysis of the Latin American Section of COMOESTAS Project. J Headache Pain 2015; 16:83. [PMID: 26382855 PMCID: PMC4573742 DOI: 10.1186/s10194-015-0561-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 08/01/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Data on the characteristics of Medication Overuse Headache (MOH) in Latin American (LA) are scarce. Here we report the demographic and clinical features of the MOH patients from Argentina and Chile enrolled in the multinational COMOESTAS project in the period 2008-2010. METHODS The LA population was formed by 240 MOH subjects, 110 from Chile and 130 from Argentina, consecutively attending the local headache centres. In each centre, specifically trained neurologist interviewed and confirmed the diagnosis according to the ICHD-II criteria. A detailed history was collected on an electronic patient record form. RESULTS The mean patient age was 38.6 years, with a female/male ratio of 8:2. The mean time since onset of the primary headache was 21 years, whereas duration of MOH was 3.9 years. The primary headache was migraine without aura in 77.5 % and migraine with aura in 18.8 %. Forty two % of the patients self-reported emotional stress associated with the chronification of headache; 43.8 % reported insomnia. The most overused medications were acute drug combinations containing ergotamine (70 %), NSAIDs (33.8 %) and triptans (5.4 %). CONCLUSION Though little described, MOH is present also in LA, where it affects mostly women, in the most active decades of life. Some differences emerge as regards the demographic and clinical characteristics of MOH in this population as compared to Europe or Northern America. What seems more worrying about MOH in Argentina and Chile is that most patients overuse ergotamine, a drug that may cause serious adverse events when used chronically. These findings once more underscore the importance of properly diagnose and treat MOH.
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Affiliation(s)
- Beatriz Shand
- Department of Neurology, Pontificia Universidad Católica of Chile, Santiago, Chile.
| | - Maria Teresa Goicochea
- Integral Pain Centre, Fundación para la Lucha contra las Enfermedades Neurológicas Infantiles (FLENI), Buenos Aires, Argentina.
| | - Raul Valenzuela
- Department of Neurology, Pontificia Universidad Católica of Chile, Santiago, Chile.
| | - Ricardo Fadic
- Department of Neurology, Pontificia Universidad Católica of Chile, Santiago, Chile.
| | - Rigmor Jensen
- Danish Headache Centre, Glostrup Amtssygehuset, University of Copenhagen, Copenhagen, Denmark.
| | - Cristina Tassorelli
- Headache Science Centre, C. Mondino National Neurological Institute, Pavia, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | - Giuseppe Nappi
- Headache Science Centre, C. Mondino National Neurological Institute, Pavia, Italy.
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Göbel H, Heinze-Kuhn K, Petersen I, Göbel C, Göbel A, Heinze A. [Classification and therapy of medication-overuse headache: impact of the third edition of the International Classification of Headache Disorders]. Schmerz 2015; 28:191-204; quiz 205-6. [PMID: 24718751 DOI: 10.1007/s00482-014-1393-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The diagnosis of medication-overuse headache (MOH) is of central importance because this secondary headache disorder can be treated very effectively and patients do not usually respond to headache prophylaxis as long as MOH persists. The article describes important changes in the diagnostic criteria of different MOH subtypes after publication of the International Classification of Headache Disorders (ICHD-3beta) in 2013. The new classification has a crucial and direct impact on prevention and treatment of MOH. In addition interactions exist with the new criteria of chronic migraine. With a controlled medication intake scheme according to the 10-20 rule and using a medication break, MOH usually remits in most patients. If patient education and advice does not lead to remission of MOH, a specialized managed medication break or withdrawal treatment becomes necessary. This can be done on an outpatient, day clinic or inpatient basis. In uncomplicated cases, the results of these three treatment settings do not differ. From a cost-effectiveness standpoint, the outpatient treatment should be given priority. In complicated cases, a fully inpatient withdrawal treatment using a multimodal treatment concept is significantly superior.
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Affiliation(s)
- H Göbel
- Migräne- und Kopfschmerzzentrum, Neurologisch-verhaltensmedizinische Schmerzklinik Kiel, Heikendorfer Weg 9-27, 24149, Kiel, Deutschland,
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Kristoffersen ES, Straand J, Vetvik KG, Benth JŠ, Russell MB, Lundqvist C. Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial. J Neurol Neurosurg Psychiatry 2015; 86:505-12. [PMID: 25112307 PMCID: PMC4413802 DOI: 10.1136/jnnp-2014-308548] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/09/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND Medication-overuse headache (MOH) is common in the general population. We investigated effectiveness of brief intervention (BI) for achieving drug withdrawal in primary care patients with MOH. METHODS The study was double-blind, pragmatic and cluster-randomised controlled. A total of 25,486 patients (age 18-50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and were randomised to receive BI training (23 GPs) or to continue business as usual (BAU; 27 GPs). The Severity of Dependence Scale was applied as a part of the BI. BI involved feedback about individual risk of MOH and how to reduce overuse. Primary outcome measures were reduction in medication and headache days/month 3 months after the intervention and were assessed by a blinded clinical investigator. RESULTS 42% responded to the postal screening questionnaire, and 2.4% screened positive for MOH. A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study. BI was significantly better than BAU for the primary outcomes (p<0.001). Headache and medication days were reduced by 7.3 and 7.9 (95% CI 3.2 to 11.3 and 3.2 to 12.5) days/month in the BI compared with the BAU group. Chronic headache resolved in 50% of the BI and 6% of the BAU group. CONCLUSIONS The BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH. TRIAL REGISTRATION NUMBER NCT01314768.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Jørund Straand
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Kjersti Grøtta Vetvik
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway
| | - Jūratė Šaltytė Benth
- HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
| | - Michael Bjørn Russell
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
| | - Christofer Lundqvist
- HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway
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Pathophysiology of Medication Overuse Headache: Current Status and Future Directions. PATHOPHYSIOLOGY OF HEADACHES 2015. [DOI: 10.1007/978-3-319-15621-7_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gómez-Beldarrain M, Anton-Ladislao A, Aguirre-Larracoechea U, Oroz I, García-Moncó JC. Low cognitive reserve is associated with chronic migraine with medication overuse and poor quality of life. Cephalalgia 2014; 35:683-91. [DOI: 10.1177/0333102414553822] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 09/08/2014] [Indexed: 01/03/2023]
Abstract
Objective The objective of this article is to test the hypothesis that cognitive reserve (CR) is related to migraine chronification, medication overuse and poor quality of life in migraineurs. Design/methods A cross-sectional study on patients with chronic migraine with medication overuse (CM-MOH), episodic migraine (EM), and controls, matched by sex, age and education, was carried out. CR was assessed by a specific questionnaire, and quality of life was measured by general and specific questionnaires (SF-36 and MSQoL). Migraine Disability Assessment Scale and Beck questionnaires for depression and anxiety were used. Medication dependence was evaluated by the medication-dependence questionnaire in headache (MDQ-H). Results Fifty-five individuals were enrolled: 18 CM-MOH patients (32.73%), 22 EM patients (40%) and 15 controls (27.27%). Fifty (90.91%) of them were females and aged 43.53 (7.54) years. Univariate analysis showed a significant association between the study group and CR, and all items of the SF-36, anxiety and depression questionnaires, MSQoL and MDQ-H. The lower CR and CM-MOH group were related to a worse quality of life, more anxiety and depression and the highest medication dependence scores. Multivariate analysis showed that higher CR scores were related to higher quality of life as measured by the physical and mental composite scores of the SF-36, and to lower anxiety (beta = −1.08, p = 0.001) and depression (beta = −0.56, p = 0.03) levels. Focusing on MSQoL, the increase in CR was predictive of a better quality of life (beta = 1.88, p < 0.0001). By all the models, the explained variance of the sample ranged from 39% (mental composite score) to 58% (MSQoL). Conclusions Low CR appears to be an independent factor associated with the deterioration of quality of life, the presence of anxiety and depression, and drug dependence and medication overuse in CM-MOH.
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Affiliation(s)
| | - Ane Anton-Ladislao
- REDISSEC, Health Services Research on Chronic Patients Network Research Unit Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - Urko Aguirre-Larracoechea
- REDISSEC, Health Services Research on Chronic Patients Network Research Unit Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - Isabel Oroz
- Service of Neurology Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
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Abstract
BACKGROUND Medication overuse headache (MOH) affects between 1% and 2% of the general population but is present in up to 50% of patients seen in headache centers. There are currently no internationally accepted guidelines for treatment of MOH. METHODS A review of the current literature on MOH treatment and pathophysiology. RESULTS We conclude that headache frequency can be reduced to episodic headache in more than 50% of the patients by simple detoxification and information. Approximately half the patients will not have need for prophylactic medication after withdrawal. Pain perception is altered in patients with MOH but can be restored to a baseline pattern, indicating a reversible mechanism in the central sensitization leading to chronic pain. The great comorbidity with depression and anxiety could be a consequence of the altered serotonin metabolism indicating a reversible and potentially treatable condition. CONCLUSION Increased focus on MOH is extremely important, as MOH both can and should be treated and prevented. MOH is thus a diagnosis that should be considered in all chronic headache patients as the very first step in their management strategy. In the general population, prevention campaigns against MOH are essential to minimize chronic pain disability.
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Affiliation(s)
- Signe B Munksgaard
- Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark
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Abstract
Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1%–2%. It is a severe form of headache where the patients often have a long history of headache and of unsuccessful treatments. MOH is characterized by chronic headache and overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This review focuses on aspects of epidemiology, diagnosis, pathogenesis, prevention, and treatment of MOH. We suggest that information and education about the risk of MOH is important since the condition is preventable. Most patients experience reduction of headache days and intensity after successful treatment. The first step in the treatment of MOH should be carried out in primary care and focus primarily on withdrawal, leaving prophylactic medication to those who do not manage primary detoxification. For most patients, a general practitioner can perform the follow-up after detoxification. More complicated cases should be referred to neurologists and headache clinics. Patients suffering with MOH have much to gain by an earlier treatment-focused approach, since the condition is both preventable and treatable.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Research Centre, Akershus University Hospital, Lørenskog, Norway ; Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway ; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Research Centre, Akershus University Hospital, Lørenskog, Norway ; Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway ; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
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Hedenrud T, Babic N, Jonsson P. Medication Overuse Headache: Self-Perceived and Actual Knowledge Among Pharmacy Staff. Headache 2014; 54:1019-25. [DOI: 10.1111/head.12350] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Tove Hedenrud
- Department of Public Health and Community Medicine; Institute of Medicine; University of Gothenburg; Gothenburg Sweden
| | | | - Pernilla Jonsson
- Department of Public Health and Community Medicine; Institute of Medicine; University of Gothenburg; Gothenburg Sweden
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Kristoffersen ES, Lundqvist C. Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Drug Saf 2014; 5:87-99. [PMID: 25083264 PMCID: PMC4110872 DOI: 10.1177/2042098614522683] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Medication-overuse headache (MOH) is one of the most common chronic headache disorders and a public health problem with a worldwide prevalence of 1-2%. It is a condition characterized by chronic headache and overuse of different headache medications, and withdrawal of the overused medication is recognised as the treatment of choice. However, the strategy for achieving withdrawal is, at present, based on expert opinion rather than scientific evidence, partly due to the lack of randomised controlled studies. This narrative review investigates different aspects of epidemiology, diagnosis, risk factors and pathogenesis as well as management for MOH. We suggest that the first step in the treatment of MOH should be carried out in general practice and should focus primarily on detoxification. For most patients, both prevention and follow up after detoxification can also be performed in general practice, thus freeing resources for referral of more complicated cases to headache clinics and neurologists. These suffering patients have much to gain by an earlier treatment-focused approach lower down on the treatment ladder.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, and Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Research Centre, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway, and Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway
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Abstract
PURPOSE OF REVIEW Medication-overuse headache (MOH) is a well described clinical entity. There is a growing body of knowledge on the epidemiology of MOH, risk factors, and treatment strategies. RECENT FINDINGS The International Headache Society updated the classification criteria for MOH. Population-based studies provided an insight into the prevalence and peculiarities of MOH patients in eastern Europe and Asia. Large-scaled population-based longitudinal studies made it possible to analyze risk factors leading to the development of MOH. Imaging studies helped to better understand the pathophysiology of headache chronicity. New treatment strategies have been suggested. SUMMARY MOH is a common headache disorder and a serious public health problem all over the world. Although the treatment regimen for MOH patients is straightforward and the outcomes are favorable, it is time now to move forward and establish a predictive model for early recognition of patients at high risk, to intervene early and avoid development of chronic headache.
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Affiliation(s)
- Zaza Katsarava
- Evangelic Hospital Unna, University of Duisburg-Essen, Germany.
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Westergaard ML, Hansen EH, Glümer C, Olesen J, Jensen RH. Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates: a systematic review. Cephalalgia 2013; 34:409-25. [PMID: 24293089 DOI: 10.1177/0333102413512033] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Case definitions of medication-overuse headache (MOH) in population-based research have changed over time. This study aims to review MOH prevalence reports with respect to these changes, and to propose a practical case definition for future studies based on the ICHD-3 beta. METHODS A systematic literature search was conducted to identify MOH prevalence studies. Findings were summarized according to diagnostic criteria. RESULTS Twenty-seven studies were included. The commonly used case definition for MOH was headache ≥15 days/month with concurrent medication overuse ≥3 months. There were varying definitions for what was considered as overuse. Studies that all used ICHD-2 criteria showed a wide range of prevalence among adults: 0.5%-7.2%. CONCLUSIONS There are limits to comparing prevalence of MOH across studies and over time. The wide range of reported prevalence might not only be due to changing criteria, but also the diversity of countries now publishing data. The criterion "headache occurring on ≥15 days per month" with concurrent medication overuse can be applied in population-based studies. However, the new requirement that a respondent must have "a preexisting headache disorder" has not been previously validated. Exclusion of other headache diagnoses by expert evaluation and ancillary examinations is not feasible in large population-based studies.
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Affiliation(s)
- Maria L Westergaard
- Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark
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Chu MK, Kim DW, Kim BK, Kim JM, Jang TW, Park JW, Lee KS, Cho SJ. Gender-specific influence of socioeconomic status on the prevalence of migraine and tension-type headache: the results from the Korean Headache Survey. J Headache Pain 2013; 14:82. [PMID: 24093215 PMCID: PMC3850998 DOI: 10.1186/1129-2377-14-82] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 10/01/2013] [Indexed: 11/24/2022] Open
Abstract
Background Socioeconomic status plays an important role in pain coping strategy. Its influence on migraine and tension-type headache may differ by gender. This study aimed to evaluate how socioeconomic status affects the prevalence of migraine and tension-type headache by gender. Methods We used data from the Korean Headache Survey, a population-based sample of Koreans aged 19–69 years. Education level, district size, and household income were evaluated as socioeconomic variables. Results Among 1507 participants, the 1-year prevalence rates of migraine and tension-type headache were 8.7% [95% confidence interval (CI) 1.9-4.6%] and 29.1% (95% CI 25.7-32.5%) in women and 3.2% (95% CI 1.9-4.6%) and 32.5% (95% CI 29.1-35.9%) in men, respectively. In women, multiple regression analysis found that living in rural areas was related to higher prevalence of migraine [odds ratio (OR) 4.52, 95% CI 1.85-11.02] and lower prevalence of tension-type headache (OR 0.29, 95% CI 0.15–0.58) and college-level education was related to lower prevalence of tension-type headache (OR 0.37, 95% CI 0.18–0.74). In men, multiple regression analysis failed to reveal significant influences of any socioeconomic variable on the prevalence of migraine or tension-type headache. Conclusions The influence of socioeconomic status on migraine and tension-type headache differs by gender, with women being more susceptible to socioeconomic influence.
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Affiliation(s)
- Min Kyung Chu
- Department of Neurology, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, 40, Seokwoo-dong, Hwaseong-si, Gyeonggi-do 445-170, Republic of Korea.
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Kocasoy Orhan E, Baykan B. Medication Overuse Headache: The Reason of Headache That Common and Preventable. Noro Psikiyatr Ars 2013; 50:S47-S51. [PMID: 28360584 DOI: 10.4274/npa.y7264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/02/2013] [Indexed: 12/01/2022] Open
Abstract
Medication overuse headache (MOH) is well-defined clinically and is one of the common reasons of chronic daily headache, but its pathophysiology has not been elucidated yet. MOH has varying clinical features in regard to regional, psychosocial, medical and economic factors. Even though, the studies have shown that many factors may play a role, MOH is likely to occur in patients who are prone to primary headaches. Mainstay of the treatment is to withdraw the excessively used analgesic drugs. The primary prevention with education of the patients as well as early diagnosis and treatment of MOH will reduce its increasing financial burden on both patients and countries. Meticulous and multifactorial evaluation of the disease besides the diagnosis and treatment of the comorbid diseases will reduce the risk of recurrences.
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Affiliation(s)
- Elif Kocasoy Orhan
- Istanbul University, Istanbul Medical Faculty, Department of Neurolog, Istanbul, Turkey
| | - Betül Baykan
- Istanbul University, Istanbul Medical Faculty, Department of Neurolog, Istanbul, Turkey
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Huang Q, Li W, Li N, Wang J, Tan G, Chen L, Qin G, Liang X, Zhou J. Elevated blood pressure and analgesic overuse in chronic daily headache: an outpatient clinic-based study from China. J Headache Pain 2013; 14:51. [PMID: 23773858 PMCID: PMC3691651 DOI: 10.1186/1129-2377-14-51] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 06/12/2013] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Many studies have reported that hypertension is common in chronic daily headache (CDH) and its subtype chronic migraine (CM), but the reason is still poorly understood. Our clinical literature review suggested that analgesic overuse may be associated with elevated blood pressure (BP), so we performed the present study to investigate the frequency of elevated BP and its link with analgesic overuse in CDH and its subtypes. METHODS A cross-sectional study was conducted in neurology outpatients with a diagnosis of CDH according to International Headache Society criteria. CDH patients were classified into CM and non-CM groups, and subclassified with or without analgesic overuse. RESULTS Elevated BP was present in 27.96% of CDH patients. Compared with non-CM patients, patients with CM had a longer duration of headache and more severe pain intensity, and a family history of headache and analgesic overuse were also more common, but the elevated BP frequency was not different between the two groups. Almost one-third of the patients had analgesic overuse; 96.8% of which comprised acetaminophen-containing agents. Those with analgesic overuse had a higher frequency of headache than those without analgesic overuse in both the CM and non-CM groups. CONCLUSIONS Although the CM patients had a longer duration of headache, more severe intensity, the frequency of elevated BP wasn't higher than non-CM group. Analgesic overuses maybe the reason of higher frequency of elevated BP in CDH and its subtypes. This may have predictive value for clinicians to improve CDH management.
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Affiliation(s)
- Qingqing Huang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Wangwen Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Nan Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Wang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ge Tan
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lixue Chen
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guangcheng Qin
- Laboratory Research Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiping Liang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiying Zhou
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Address:Medical College, Road No.1, Yuzhong District, Chongqing, China
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Jonsson P, Jakobsson A, Hensing G, Linde M, Moore CD, Hedenrud T. Holding on to the indispensable medication--a grounded theory on medication use from the perspective of persons with medication overuse headache. J Headache Pain 2013; 14:43. [PMID: 23697986 PMCID: PMC3671143 DOI: 10.1186/1129-2377-14-43] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 05/17/2013] [Indexed: 12/02/2022] Open
Abstract
Background Medication overuse headache (MOH) is a chronic headache disorder, caused by overuse of acute medication. To date, it remains unclear why some people overuse these medications. The aim of this qualitative study was to explore how individuals with MOH use medications and other strategies to manage headaches in their daily lives, and their thoughts about their own use of acute medication. Our intention was to develop a theoretical model about the development of MOH, from the perspective of those with MOH. Methods Data collection and analysis were conducted according to grounded theory methodology. The participants were recruited via newspaper advertisements. Fourteen persons with MOH were interviewed in individual qualitative interviews. Results The basic process leading to medication overuse was holding on to the indispensable medication. The acute medication was indispensable to the participants because they perceived it as the only thing that could prevent headaches from ruining their lives. The participants perceived headaches as something that threatened to ruin their lives. As a result, they went to great lengths trying to find ways to manage it. They tried numerous strategies. However, the only strategy actually perceived as effective was the use of acute medication and they eventually became resigned to the idea that it was the only effective aid. The acute medication thus became indispensable. Their general intention was to use as little medication as possible but they found themselves compelled to medicate frequently to cope with their headaches. They did not like to think about their medication use and sometimes avoided keeping track of the amount used. Conclusions This qualitative study adds understanding to the process via which MOH develops from the perspective of those having MOH. Such knowledge may help bridge the gap between the perspectives of patients and health-care professionals.
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Affiliation(s)
- Pernilla Jonsson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 453SE 40530, Gothenburg, Sweden.
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Shah AM, Bendtsen L, Zeeberg P, Jensen RH. Reduction of Medication Costs After Detoxification for Medication-Overuse Headache. Headache 2012; 53:665-72. [DOI: 10.1111/head.12031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Asif M. Shah
- Department of Neurology; Danish Headache Center; Glostrup Hospital; University of Copenhagen; Glostrup; Denmark
| | - Lars Bendtsen
- Department of Neurology; Danish Headache Center; Glostrup Hospital; University of Copenhagen; Glostrup; Denmark
| | - Peter Zeeberg
- Department of Neurology; Danish Headache Center; Glostrup Hospital; University of Copenhagen; Glostrup; Denmark
| | - Rigmor H. Jensen
- Department of Neurology; Danish Headache Center; Glostrup Hospital; University of Copenhagen; Glostrup; Denmark
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Allena M, Cuzzoni MG, Tassorelli C, Nappi G, Antonaci F. An electronic diary on a palm device for headache monitoring: a preliminary experience. J Headache Pain 2012; 13:537-41. [PMID: 22842873 PMCID: PMC3444534 DOI: 10.1007/s10194-012-0473-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 07/12/2012] [Indexed: 11/26/2022] Open
Abstract
Patients suffering from headache are usually asked to use charts to allow monitoring of their disease. These diaries, providing they are regularly filled in, become crucial in the diagnosis and management of headache disorders because they provide further information on attack frequency and temporal pattern, drug intake, trigger factors, and short-/long-term responses to treatment. Electronic tools could facilitate diary monitoring and thus the management of headaches. Medication overuse headache (MOH) is a chronic and disabling condition that can be treated by withdrawing the overused drug(s) and adopting specific approaches that focus on the development of a close doctor–patient relationship in the post-withdrawal phase. Although the headache diary is, in this context, an essential tool for the constant, reliable monitoring of these patients to prevent relapses, very little is known about the applicability of electronic diaries in MOH patients. The purpose of this study was to evaluate the acceptability of and patient compliance with an electronic headache diary (palm device) as compared with a traditional diary chart in a group of headache inpatients with MOH. A palm diary device, developed in accordance with the ICHD-II criteria, was given to 85 MOH inpatients during the detoxification phase. On the first day of hospitalization, the patients were instructed in the use of the diary and were then required to fill it in daily for the following 7 days. Data on the patients’ opinions on the electronic diary and the instructions given, its screen and layout, as well as its convenience and ease of use, in comparison with the traditional paper version, were collected using a numerical rating scale. A total of 504 days with headache were recorded in both the electronic and the traditional headache diaries simultaneously. The level of patient compliance was good. The patients appreciated the electronic headache diary, deeming it easy to understand and to use (fill in); most of the patients rated the palm device handier than the traditional paper version.
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Affiliation(s)
- Marta Allena
- Headache Science Centre, C. Mondino National Institute of Neurology Foundation IRCCS, Pavia, Italy
| | | | - Cristina Tassorelli
- Headache Science Centre, C. Mondino National Institute of Neurology Foundation IRCCS, Pavia, Italy
| | - Giuseppe Nappi
- Headache Science Centre, C. Mondino National Institute of Neurology Foundation IRCCS, Pavia, Italy
| | - Fabio Antonaci
- Headache Science Centre, C. Mondino National Institute of Neurology Foundation IRCCS, Pavia, Italy
- University Consortium for Adaptive Disorders and Head pain (UCADH), Pavia, Italy
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