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Pack A, O'Conor R, Curran Y, Huang W, Zuleta A, Zuleta R, Herman MP, Kymes SM, Bailey SC. Delayed opportunities for patient-provider communication about medication overuse headache: Mixed methods perspectives from patients and neurologists. Prev Med Rep 2024; 40:102659. [PMID: 38435414 PMCID: PMC10906507 DOI: 10.1016/j.pmedr.2024.102659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
Objectives Medication overuse headache (MOH) is a common, debilitating condition occurring when migraine patients overuse pain relief medications. We conducted a convergent mixed methods study examining patient-provider communication on MOH. Methods Migraine patients were identified from one academic health center via electronic health records. Research staff recruited patients and administered a remote survey on MOH awareness, knowledge, and communication; descriptive and bivariate analyses were conducted. Neurologists from the same health center were invited to participate in qualitative interviews; analysis drew from the Rapid Identification of Themes from Audio Recordings procedures. A side-by-side comparison of results followed. Results Participants included 200 patients and 13 neurologists. More than one third of patients (39.5 %) had never heard of 'medication overuse headache.' Among those who had, 38.4 % learned about MOH ≥ 5 years after their migraine diagnosis. Neurologists similarly reported limited patient awareness of MOH and suggested communication was provider-initiated, reactive to patient-reported symptoms and behaviors. Participants agreed MOH was described as a 'consequence' of frequent medication taking, though specific terminology varied with neurologists suggesting they choose terms they perceive to be easier to understand and less stigmatizing to patients. Neurologists felt they lacked effective patient education resources. Conclusions Findings reveal delayed opportunities to inform patients about MOH. Standardized education supporting early preventive communication is needed, perhaps in primary care where many patients seek initial care for migraine symptoms.
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Affiliation(s)
- Allison Pack
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rachel O'Conor
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Yvonne Curran
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Wei Huang
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Andrea Zuleta
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Rodolfo Zuleta
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | | | | | - Stacy C. Bailey
- Division of General Internal Medicine, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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Krymchantowski A, Jevoux C, Krymchantowski AG, Ramos LB, Barbosa JSS, Silva-Neto RP. Medication-overuse headache-a review of different treatment strategies. FRONTIERS IN PAIN RESEARCH 2023; 4:1103497. [PMID: 37881687 PMCID: PMC10597723 DOI: 10.3389/fpain.2023.1103497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/23/2023] [Indexed: 10/27/2023] Open
Abstract
Medication-overuse headache (MOH) can develop from primary headaches. MOH is usually the result of overuse of symptomatic medications. It is a noteworthy personal and societal burden. The identification and treatment of patients at risk for MOH is an essential component of MOH management. Medication overuse can be modifiable and can advance from episodic to chronic migraine. Treatment for MOH is complex, and experts in the field have varied views on the most appropriate strategy for MOH treatment. The objective of this review is to give a comprehensive synopsis of the literature for the management of MOH. Treatment strategies, such as detoxification and prevention, are the debatable issues. Medication withdrawal is the foundation for management. The available literature suggested abrupt withdrawal with preventive approaches for early management. Bridging therapy could be useful to get relief from withdrawal symptoms. Multidisciplinary choices proved beneficial in supporting withdrawal and preventing relapse. Worldwide, the termination of overused medications has been observed as a standard treatment strategy; however, patient-specific approaches should be taken.
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Lau CI, Chen WH, Wang HC, Walsh V. Decision-making impairment under ambiguity but not under risk may underlie medication overuse in patients with chronic migraine. Headache 2023; 63:822-833. [PMID: 37232343 DOI: 10.1111/head.14513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/26/2023] [Accepted: 03/06/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To explore whether patients with chronic migraine and medication overuse headache (CM + MOH) present with decision-making deficit. BACKGROUND Factors underlying MOH in patients with CM remain unclear. Whether the process of decision-making plays a role in MOH is still controversial. Decision-making varies in the degree of uncertainty: under ambiguity where the probability of outcome is unknown, and under risk where probabilities are known. METHODS Decisions under ambiguity and risk were assessed with the Iowa Gambling Task and the Cambridge Gambling Task, respectively, whereas executive function was assessed by the Wisconsin Card Sorting Test. RESULTS A total of 75 participants: 25 patients with CM + MOH, 25 with CM, and 25 age- and sex-similar healthy controls (HCs), completed this cross-sectional study. There was no significant difference in headache profiles except for more frequent analgesic use (mean ± SD: 23.5 ± 7.6 vs. 6.8 ± 3.4 days; p < 0.001) and higher Severity of Dependence Scores (median [25th-75th percentile]: 8 [5-11] vs. 1 [0-4]; p < 0.001) in patients with CM + MOH compared to CM. Total net score (mean ± SD) on the Iowa Gambling Task in patients with CM + MOH, CM, and HCs were - 8.1 ± 28.7, 10.9 ± 29.6, and 14.2 ± 28.8, respectively. There was a significant difference between the three groups (F(2, 72) = 4.28, p = 0.017), with patients with CM + MOH making significantly more disadvantageous decisions than patients with CM (p = 0.024) and HCs (p = 0.008), while the CM and HC groups did not differ (p = 0.690). By contrast, there was no significant difference between the groups in the Cambridge Gambling Task and the Wisconsin Card Sorting Test. Furthermore, performance on the Iowa Gambling Task was inversely correlated with analgesic consumption (r = -0.41, p = 0.003), suggesting that decision-making under ambiguity may be related to MOH. CONCLUSIONS Our data suggest that patients with CM + MOH had impaired decisions under ambiguous, but not risky situations. This dissociation indicates disrupted emotional feedback processing rather than executive dysfunction, which may underlie the pathogenesis of MOH.
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Affiliation(s)
- Chi Ieong Lau
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, UK
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei, Taiwan
- College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
- Department of Medicine, University Hospital, Taipa, Macau
| | - Wei-Hung Chen
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Han-Cheng Wang
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Vincent Walsh
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, UK
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Agbetou M, Adoukonou T. Lifestyle Modifications for Migraine Management. Front Neurol 2022; 13:719467. [PMID: 35370920 PMCID: PMC8971279 DOI: 10.3389/fneur.2022.719467] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Migraine is a disabling disease that inflicts a heavy burden on individuals who suffer from it. Significant advances are being made in understanding the pathophysiology and treatment of the disease. The role of lifestyle modifications has become increasingly predominant. We reviewed the current and available data on the role of a healthy lifestyle in the management of migraine. Physical activity, management of obesity, a healthy diet, and a better lifestyle, such as adequate sleep and avoidance of drug abuse, significantly contribute to reducing the frequency and severity of attacks. It is important to consider these factors in the overall management strategies for migraine sufferers.
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Affiliation(s)
- Mendinatou Agbetou
- Department of Neurology, University of Parakou, Parakou, Benin
- Clinic of Neurology, Teaching Hospital of Parakou, Parakou, Benin
| | - Thierry Adoukonou
- Department of Neurology, University of Parakou, Parakou, Benin
- Clinic of Neurology, Teaching Hospital of Parakou, Parakou, Benin
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- *Correspondence: Thierry Adoukonou
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Mose LS, Jensen RH, Nygaard NPB, Pedersen SS, Gram B. Use of coping strategies in the management of medication overuse headache. PATIENT EDUCATION AND COUNSELING 2022; 105:390-397. [PMID: 34059361 DOI: 10.1016/j.pec.2021.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/20/2021] [Accepted: 05/21/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Use of Motivational Interviewing (MI) in education may improve medication-overuse headache (MOH) patients' ability to cope with pain. In a randomised controlled trial, we evaluated the effect of education focusing on behavioural change among MOH patients. METHODS Ninety-eight MOH patients were randomized (1:1) to standard treatment and 12-weeks of MI-based education versus standard treatment alone after detoxification. Outcome of interest was changes in coping strategies measured by the Coping Strategy Questionnaire at four- and nine months. RESULTS The educational program improved patients' perceived efficacy in the use of their coping strategies to control pain, both at four-and nine months follow-up (mean±SE): ∆:0.84 ± 0.35, 95% CI:0.16;1.52, p = 0.02 and: ∆: 0.90 ± 0.39, 95% CI:0.14;1.66, p = 0.02, respectively. No between-group differences were detected in the other coping subscales. Within the intervention group, the coping strategy subscales Catastrophizing, and Reinterpretation of pain sensation were significantly improved at nine months follow-up (p = 0.003 vs. p = 0.012, respectively). No changes were found in the control group. CONCLUSION MI-based education focused on behavioural changes improved MOH patients' perceived efficacy in the use of their coping strategies to control pain. PRACTICE IMPLICATIONS Education based on MI could be valuable for MOH patients with respect to behavioural changes and perceived headache control.
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Affiliation(s)
- Louise Schlosser Mose
- Department of Neurology, University hospital of Southern Denmark, Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark; Research Unit of Health Sciences, University hospital of Southern Denmark, Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Centre, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Niels-Peter Brøchner Nygaard
- Research Unit of Health Sciences, University hospital of Southern Denmark, Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense, Denmark
| | - Susanne Schmidt Pedersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense, Denmark; Department of Cardiology, Odense University Hospital, Winsløws vej 4, 5000 Odense, Denmark
| | - Bibi Gram
- Research Unit of Health Sciences, University hospital of Southern Denmark, Esbjerg, Finsensgade 35, 6700 Esbjerg, Denmark; Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, 5000 Odense, Denmark.
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Mose LS, Bornhøft JO, Primdahl J, Gram B. Coping and Motivation for Change-An Interview Study of the Experience From Participation in an Educational Program for Patients With Medication-Overuse Headache. J Patient Exp 2021; 8:23743735211034289. [PMID: 34395849 PMCID: PMC8358482 DOI: 10.1177/23743735211034289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Patient educational programs (PEP) are recommended as part of the treatment for medication-overuse headache (MOH), however, knowledge of patients' experiences when participating is sparse. This study explored how patients experienced participating in a PEP focusing on empowering coping strategies and motivation for behavioral changes. Eight individual semistructured interviews were conducted among patients suffering from MOH who had attended a PEP intervention in a randomized controlled trial. The PEP involved techniques from Motivational Interviewing as its communicative approach. Data collection, analysis, and interpretation were performed within a phenomenological-hermeneutic framework. Results showed that patients found the educational program relevant regarding coping with headache. Participants shifted from focusing on medication to include other ways to manage headache. Experiences regarding ambivalent feelings for behavioral change and feelings of stigmatization were key issues. Participation in this PEP helped the participants cope with headache in new ways relevant to their everyday lives and challenges. The individualized approach enabled by Motivational Interviewing was experienced as useful by the participants, as it actively involved them in the treatment.
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Affiliation(s)
- Louise Schlosser Mose
- Department of Neurology, University Hospital of Southern Denmark, Esbjerg, Denmark.,Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jane Orry Bornhøft
- Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Endocrinology, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Bibi Gram
- Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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7
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Grazzi L, Andrasik F, Rizzoli P, Bernstein C, Sansone E, Raggi A. Acceptance and commitment therapy for high frequency episodic migraine without aura: Findings from a randomized pilot investigation. Headache 2021; 61:895-905. [PMID: 34115399 DOI: 10.1111/head.14139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/22/2021] [Accepted: 03/25/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We compared the incremental effects of adding acceptance and commitment therapy (ACT) to pharmacological treatment as usual (TAU) in a sample of patients with high frequency episodic migraine without aura (HFEM), assessing impact on a spectrum of measures across multiple domains. BACKGROUND Patients with HFEM are at risk of developing chronic migraine and medication overuse headache. ACT has been shown to be effective for the treatment of various chronic pain conditions, but little attention has been given to its therapeutic value in the management of recurring headaches. METHODS In this single-blind (masking for outcome assessor), open-label, randomized clinical trial, 35 patients with HFEM, with a monthly headache frequency ranging from 9 to 14 days, were recruited at the headache center of C. Besta Neurological Institute and randomized to either TAU (patient education and pharmacological prophylaxis; n = 17) or TAU + ACT (n = 18). Patients assigned to the combined treatment arm additionally received six 90-min weekly group sessions of ACT therapy and two supplementary "booster" sessions. All patients were on a stable course of prophylactic medication in the 3 months prior to initiating either treatment. Monthly headache frequency served as the primary outcome measure, with all other data collected being considered as secondary measures (medication intake, disability, headache impact, anxiety and depression, catastrophizing, allodynia, cognitive inflexibility, pain acceptance, mindful attention and awareness). RESULTS A total of 35 patients were enrolled: 17 randomized to TAU, of whom three dropped out, and 18 to TAU + ACT (no dropouts in this group). Headache frequency and medication intake decreased in both groups over 12 months, with patients in the TAU + ACT group showing statistically significant reduction earlier, that is, by month 3. Headache frequency was reduced by 3.3 days (95% CI: 1.4 to 5.2) among those randomized to ACT + TAU, whereas it increased by 0.7 days (95% CI: -2.7 to 1.3) among those randomized to TAU only (p = 0.007, partial η2 = 0.21), the difference being 4 days (95% CI: 1.2 to 6.8). Medication intake was reduced by 4.1 intakes (95% CI: 2.0 to 6.3) among those randomized to ACT + TAU and by 0.4 intakes (95% CI: -1.8 to 2.5) among those randomized to TAU only (p = 0.016; partial η2 = 0.17), the difference being 3.8 intakes (95% CI: 0.7 to 6.8). At 6 and 12 months, the variations were not different between the two groups for headache frequency and medication intake. The opposite was found for measures of headache impact and pain acceptance, where the differences over time favored patients allocated to TAU. Both groups improved with regard to measures of disability, anxiety and depression, catastrophizing, and cognitive inflexibility, whereas measures of allodynia and pain acceptance were stable over time. CONCLUSIONS Our preliminary findings indicate that supplementing TAU with ACT can enhance the main clinical outcomes, namely headache frequency and medication intake of patients with HFEM.
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Affiliation(s)
- Licia Grazzi
- Dipartimento Neuroalgologia Centro Cefalee, Fondazione IRRCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Frank Andrasik
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Paul Rizzoli
- John Graham Headache Center, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolyn Bernstein
- John Graham Headache Center, Brigham and Women's/Faulkner Hospital, Harvard Medical School, Boston, MA, USA
| | - Emanuela Sansone
- UO Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- UO Neurologia Salute Pubblica e Disabilità, Fondazione IRRCS Istituto Neurologico Carlo Besta, Milano, Italy
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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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9
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Verhaak AMS, Williamson A, Johnson A, Murphy A, Saidel M, Chua AL, Minen M, Grosberg BM. Migraine diagnosis and treatment: A knowledge and needs assessment of women's healthcare providers. Headache 2020; 61:69-79. [PMID: 33377176 DOI: 10.1111/head.14027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/23/2020] [Accepted: 10/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies suggest that migraine is often underdiagnosed and inadequately treated in the primary care setting, despite many patients relying on their primary care provider (PCP) to manage their migraine. Many women consider their women's healthcare provider to be their PCP, yet very little is known about migraine knowledge and practice patterns in the women's healthcare setting. OBJECTIVE The objective of this study was to assess women's healthcare providers' knowledge and needs regarding migraine diagnosis and treatment. METHODS The comprehensive survey assessing migraine knowledge originally developed for PCPs was used in this study, with the addition of a section regarding the use of hormonal medications in patients impacted by migraine. Surveys were distributed online, and primarily descriptive analyses were performed. RESULTS The online survey was completed by 115 women's healthcare providers (response rate 28.6%; 115/402), who estimated that they serve as PCPs for approximately one-third of their patients. Results suggest that women's healthcare providers generally recognize the prevalence of migraine, but experience some knowledge gaps regarding migraine management. Despite 82.6% (95/115) of survey respondents feeling very comfortable or somewhat comfortable with diagnosing migraine, only 57.9% (66/114) reported routinely asking patients about headaches during annual visits. Very few were familiar with the American Academy of Neurology guidelines on preventative treatment (6.3%; 7/111) and the Choosing Wisely Campaign recommendations on migraine treatment (17.3%; 19/110), and many prescribed medications known to contribute to medication overuse headache. In addition, only 24.3% (28/115) would order imaging for a new type of headache, 35.7% (41/115) for worsening headache, and 47.8% (55/115) for headache with neurologic symptoms; respondents cited greater tendency with sending patients to an emergency department for the same symptoms. Respondents had limited knowledge of evidence-based, non-pharmacological treatments for migraine (i.e., biofeedback or cognitive behavioral therapy), with nearly none placing referrals for these services. Most providers were comfortable prescribing hormonal contraception (mainly progesterone only) to women with migraine without aura (80.9%; 89/110) and with aura (72.5%; 79/109), and followed American College of Obstetricians and Gynecologists (ACOG) guidelines to limit combination hormonal contraception for patients with aura. When queried, 6.3% or less (5/79) of providers would prescribe estrogen-containing contraception for women with migraine with aura. Only 37.3% (41/110) of respondents reported having headache/migraine education. Providers indicated interest in education pertaining to migraine prevention and treatment (96.3%; 105/109), migraine-associated disability (74.3%; 81/109), and diagnostic testing (59.6%; 65/109). CONCLUSION Women's healthcare providers appear to have several knowledge gaps regarding the management of migraine in their patients. These providers would likely benefit from access to a headache-specific educational curriculum to improve provider performance and patient outcomes.
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Affiliation(s)
- Allison M S Verhaak
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, CT, USA.,Division of Health Psychology, The Institute of Living/Hartford Hospital, Hartford, CT, USA
| | - Anne Williamson
- Research Department, Hartford Healthcare, West Hartford, CT, USA
| | - Amy Johnson
- Department of Obstetrics and Gynecology, University of Connecticut School of Medicine, Farmington, CT, USA.,Department of Obstetrics and Gynecology, Hartford HealthCare, West Hartford, CT, USA
| | - Andrea Murphy
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, CT, USA
| | | | - Abigail L Chua
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, CT, USA.,Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Mia Minen
- Department of Neurology, New York University School of Medicine, New York, NY, USA.,Department of Population Health, New York University School of Medicine, New York, NY, USA
| | - Brian M Grosberg
- Hartford Healthcare Headache Center, Ayer Neuroscience Institute, West Hartford, CT, USA.,Department of Neurology, University of Connecticut School of Medicine, Farmington, CT, USA
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10
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Lau CI, Liu MN, Chen WH, Walsh V, Wang SJ. Clinical and biobehavioral perspectives: Is medication overuse headache a behavior of dependence? PROGRESS IN BRAIN RESEARCH 2020; 255:371-402. [PMID: 33008514 DOI: 10.1016/bs.pbr.2020.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 02/08/2023]
Abstract
Medication overuse headache (MOH), previously known as analgesic abuse headache or medication misuse headaches, is a common form of chronic headache disorder that has a detrimental impact on health and society. Although it has been widely accepted that overusing abortive medications is paradoxically the cause of MOH and drug discontinuation is the treatment of choice, ongoing debates exist as to whether drug consumption per se is the cause or consequence of headache chronification. Certain features in MOH such as their compulsive drug-seeking behavior, withdrawal headaches and high relapse rates share similarities with drug dependence, suggesting that there might be common underlying biological and psychobehavioral mechanisms. In this regard, this article will discuss the updated evidence and current debates on the possible biobehavioral overlap between MOH and drug dependence. To begin with, we will discuss whether MOH has characteristics of substance dependence based on standard psychiatry diagnostic criteria and other widely used dependence scales. Recent epidemiological studies underscoring common psychiatric comorbidities between the two disorders will also be presented. Although both demonstrate seemingly distinct personality traits, recent studies revealed similar decision-making impairment from a cognitive perspective, indicating the presence of a maladaptive reward system in both disorders. In addition, emerging imaging studies also support this notion by showing reversible morphological and functional brain changes related to the mesocorticolimbic reward circuitry in MOH, with a strong resemblance to those in addiction. Finally, an increased familial risk for drug dependence and genetic association with dopaminergic and drug dependence molecular pathways in MOH also support a possible link between MOH and addiction. Understanding the role of dependence in MOH will have a great impact on disease management as this will provide the missing piece of the puzzle in current therapeutic strategies.
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Affiliation(s)
- Chi Ieong Lau
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan; University Hospital, Taipa, Macau
| | - Mu-N Liu
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, Memory and Aging Centre, University of California, San Francisco, CA, United States
| | - Wei-Hung Chen
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Vincent Walsh
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Brain Research Center and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Vandenbussche N, Paemeleire K, Katsarava Z. The Many Faces of Medication-Overuse Headache in Clinical Practice. Headache 2020; 60:1021-1036. [PMID: 32232847 DOI: 10.1111/head.13785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 12/24/2022]
Abstract
The management of medication-overuse headache (MOH) is multifaceted and headache experts have different views on the optimal strategy to tackle this type of secondary headache. The purpose of this review is to provide an overview of the literature on the management of MOH, and to highlight important considerations in the clinical evaluation of the MOH patient. Managing MOH in clinical practice starts by evaluating the headache patient with medication overuse, determining the overused drug(s), assessing the impact of headaches on the patient and assessing comorbid conditions and disorders. Withdrawal of the overused medication is the cornerstone of treatment. An inpatient or outpatient setting is chosen based on the clinical profile of the patient. There is evidence for abrupt withdrawal combined with headache preventive treatment. Bridging therapy to bring relief to withdrawal headaches and/or symptoms should be offered. Education and motivational work through multidisciplinary assessment show benefits in sustaining withdrawal and preventing relapse. Although the reversal of chronic headache after cessation of overused acute medication has been noticed worldwide, different aspects of the management of MOH, such as complete or gradual withdrawal, or preventive treatment with or without withdrawal are still debated.
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Affiliation(s)
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, Essen, Germany.,Department of Neurology, Evangelical Hospital Unna, Unna, Germany.,EVEX Medical Corporation, Tbilisi, GA, USA.,Sechenov University Moscow, Moscow, Russian Federation
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12
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Mose LS, Pedersen SS, Jensen RH, Gram B. Medication-overuse headache: The effect of a patient educational programme-A randomized controlled trial. Eur J Pain 2019; 24:435-447. [PMID: 31661579 DOI: 10.1002/ejp.1500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/16/2019] [Accepted: 10/20/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little is known about the effects of non-pharmacological interventions among medication-overuse headache (MOH) patients, although non-pharmacological approaches combined with pharmacological treatment are recommended. The objective was to evaluate the effect of an educational programme as an add-on to standard treatment. METHODS Medication-overuse headache patients were randomized (1:1) in a single-centre setting to standard treatment with 12 weeks of education (I-group) versus standard treatment (C-group). The primary outcome was measurement of reduction in headache days/last month at 9 months' follow-up. Secondary outcomes were headache intensity, acute medication intake, bothersomeness, disability, physical activity and patient satisfaction. The between-group differences were analysed using a mixed-effects model for repeated measurements with a between group factor (I-group vs. C-group) and a time factor (baseline, 4 and 9 months). RESULTS Ninety-eight patients were randomized (I-group: n = 48, C-group: n = 50), with 40 and 39 patients completing the study, respectively. Intention-to-treat analyses showed that both groups experienced statistically significant reductions in headache days/last month (I-group: -4 ± 6 days (95% CI 2.47; 5.95), p < .001) versus C-group: -4 ± 9 days ([95% CI 1.53; 6.79], p = .003), but there were no significant differences between groups (mean ± SE):Δ: 0.7 days ([95% CI, -2.50; 3.93], p = .66). At follow-up, 85% from the I-group and 86% from C-group, no longer fulfilled the criteria for MOH. CONCLUSION The compliance rate was high, indicating that patients were motivated for receiving education, but we found no additional benefits of adding an educational programme to standard treatment. Future research focusing on the MOH complexity, group heterogeneity, duration and content of educational programmes is warranted. SIGNIFICANCE Randomized controlled trials (RCTs) of non-pharmacological intervention such as patient educational programmes are of great importance, as this approach is common in the clinical practice. Medication-overuse headache (MOH) is a heterogenetic patient group, which must be taken into account when conducting RCTs of non-pharmacological interventions. An educational programme based on Motivational Interviewing is well-tolerated among MOH patients, however, no superior effects were found from adding the educational programme to standard treatment versus standard treatment alone.
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Affiliation(s)
- Louise S Mose
- Department of Neurology, University Hospital of Southern Denmark, Esbjerg, Denmark.,Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Centre, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Bibi Gram
- Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Mose LS, Pedersen SS, Jensen RH, Gram B. Personality traits in migraine and medication-overuse headache: A comparative study. Acta Neurol Scand 2019; 140:116-122. [PMID: 31038726 DOI: 10.1111/ane.13111] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Medication-overuse headache (MOH) is recognized as a biobehavioural disorder, warranting that both biological and psychological factors are targeted throughout treatment. A psychological factor of importance may be personality that could be used to tailor treatment if differences are found across headache diagnoses. The objectives were as follows: (a) To investigate if migraine patients and patients with MOH differed on personality traits, (b) To investigate if the two headache groups differed from a Danish normative sample, with respect to personality traits. MATERIALS AND METHODS The NEO-Five-Factor Inventory was completed, and an age-matched cohort of episodic migraine patients (n = 94) and MOH patients (n = 94) was included. Multivariate regression models and sex-stratified comparisons were made on patients' raw scores from five personality traits; neuroticism, extraversion, openness, agreeableness, and conscientiousness. The headache groups were also compared to personality traits from a Danish normative sample (n = 1032). RESULTS MOH females obtained significantly lower scores on extraversion (24.4 ± 4.3 vs 27.1 ± 7.2, P < 0.01), openness (23.7 ± 3.9 vs 26.2 ± 6.4, P < 0.01), and conscientiousness (28.9 ± 3.7 vs 34.6 ± 5.8, P > 0.01) as compared to female migraineurs. Males showed no differences. Compared to the normative sample, both headache groups showed a lower score on extraversion (P < 0.01). Furthermore, MOH patients had statistically significant lower scores on conscientiousness while the migraine patients had a higher score. CONCLUSION Results suggests some personality trait differences between migraine and MOH patients. Especially, females showed different personality traits, where the MOH females appeared more introvert and less socially orientated. If confirmed in larger studies, this information could be used in personalized treatment in clinical practice.
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Affiliation(s)
- Louise S. Mose
- Department of Neurology Hospital of South West Jutland Esbjerg Denmark
- Research Unit of Health Science Hospital of South West Jutland Esbjerg Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Susanne S. Pedersen
- Department of Psychology University of Southern Denmark Odense Denmark
- Department of Cardiology Odense University Hospital Odense Denmark
| | - Rigmor H. Jensen
- Danish Headache Centre, Department of Neurology Rigshospitalet‐Glostrup, University of Copenhagen Denmark
| | - Bibi Gram
- Research Unit of Health Science Hospital of South West Jutland Esbjerg Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
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Charleston L, Royce J, Monteith TS, Broner SW, O'Brien HL, Manrriquez SL, Robbins MS. Migraine Care Challenges and Strategies in US Uninsured and Underinsured Adults: A Narrative Review, Part 2. Headache 2019; 58:633-647. [PMID: 29878343 DOI: 10.1111/head.13321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To review the challenges and potential solutions in treatment options for quality migraine care in adult patients who are under or uninsured. BACKGROUND The Affordable Care Act has improved access to health care for many; however, those who are underserved continue to face treatment disparities and have inadequate access to appropriate migraine management. METHODS This manuscript is the second of a 2-part narrative review which was performed after a series of discussions within the Underserved Populations in Headache Medicine Special Interest Section meetings of the American Headache Society. Literature was reviewed for key concepts underpinning conceptual boundaries and a broad overview of the subject matter. Published guidelines, state-specific Medicaid websites, headache quality measurement sets, literature review, and expert opinion were used to tailor suggested treatment options and therapeutic strategies. In this second part of our narrative review, we explored migraine care strategies and considerations for underserved and vulnerable adult populations with migraine. RESULTS Although common, migraine remains untreated, particularly among those of low socioeconomic status. Low socioeconomic status may play an important role in the disease progression, prescription of hazardous medications such as opioids, outcomes, and quality of life of patients with migraine and other headache disorders. There are some evidence-based and guideline supported treatment options available at low cost that include prescription medications and supplements, though approved devices are costly. Resources available online and simple nonpharmacological strategies may be particularly useful in the underserved migraine population. CONCLUSIONS We identified and discussed migraine treatment barriers that affect underserved populations in the US and summarized practical, cost-effective strategies to surmount them. However, more research is needed to identify the best cost-effective measures for migraine management in underserved and vulnerable patients who are uninsured or underinsured.
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Affiliation(s)
- Larry Charleston
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Jeffrey Royce
- Neuro and Headache Center, SwedishAmerican Hospital, Rockford, IL, USA
| | - Teshamae S Monteith
- Department of Neurology-Headache Division, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Susan W Broner
- Weill Cornell Medicine Headache Program, Department of Neurology, Weill Cornell Medical College, New York, NY, USA
| | - Hope L O'Brien
- Division of Neurology, Cincinnati Children's Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Salvador L Manrriquez
- Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
| | - Matthew S Robbins
- Department of Neurology, Albert Einstein College of Medicine, Montefiore Headache Center, Bronx, NY, USA
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Esposito M, Messina A, Monda V, Bitetti I, Salerno F, Precenzano F, Pisano S, Salvati T, Gritti A, Marotta R, Lavano SM, Lavano F, Maltese A, Parisi L, Salerno M, Tripi G, Gallai B, Roccella M, Bove D, Ruberto M, Toraldo R, Messina G, Carotenuto M. The Rorschach Test Evaluation in Chronic Childhood Migraine: A Preliminary Multicenter Case-Control Study. Front Neurol 2017; 8:680. [PMID: 29312117 PMCID: PMC5733029 DOI: 10.3389/fneur.2017.00680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/29/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECT About 1.2-3.2% of children at 7 years of age with increasing age up to 4-19% in adolescents are suffering from migraine without aura (MwA). The aim of the present study is investigating the personality style associated with children and adolescents affected by MwA, administrating the Rorschach test, and comparing with typical developing healthy controls (TD). METHODS 137 patients (74 males), aged 7.3-17.4 years (mean age 11.4, SD 3.02 years), affected by MwA according to the IHs-3 criteria. The Rorschach variables were treated as numerical variables and statistically tested with t-Student's analysis. RESULTS No statistical differences were found between the MwA and TD for age (p = 0.55), and gender (p = 0.804). From the comparison between the two samples, MwA group shows lower W responses (p < 0.001), good quality W responses (p < 0.001), high frequency of detailed responses (p < 0.001), the presence of even minor form of good quality responses (p < 0.001), increased presence of animals answers (A%) (p < 0.001), more frequent trivial answers (Ban%) (p < 0.001). DISCUSSION Rorschach interpretation pinpointed many interesting and, perhaps, peculiar aspects in our MwA population such as a trend predisposition for: analytical reasoning rather than synthetic, ease/practicality rather than creativity, oppositionality rather than external adaptation to the environment that may be interpreted as effect of general maladaptivity.
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Affiliation(s)
- Maria Esposito
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ilaria Bitetti
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Filomena Salerno
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesco Precenzano
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Simone Pisano
- Department of Child and Adolescent Neuropsychiatry, University of Salerno, Salerno, Italy
| | - Tiziana Salvati
- Faculty of Education Science, University Suor Orsola Benincasa of Naples, Naples, Italy
| | - Antonella Gritti
- Faculty of Education Science, University Suor Orsola Benincasa of Naples, Naples, Italy
| | - Rosa Marotta
- Department of Medical and Surgical Science, University Magna Graecia, Catanzaro, Italy
| | | | - Francesco Lavano
- Department of Health Sciences, University “Magna Graecia”, Catanzaro, Italy
| | - Agata Maltese
- Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, Italy
| | - Lucia Parisi
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Margherita Salerno
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Gabriele Tripi
- Department PROSAMI, University of Palermo, Palermo, Italy
- Childhood Psychiatric Service for Neurodevelopmentals Disorders, Chinon, France
| | - Beatrice Gallai
- Centro per la Diagnosi e Cura dei Disturbi dell’apprendimento e del Comportamento Associazione per la ricerca scientifica Fusis, Alvignano, Italy
| | - Michele Roccella
- Child Neuropsychiatry, Department of Psychology and Pedagogical Sciences, University of Palermo, Palermo, Italy
| | - Domenico Bove
- Centro per la Diagnosi e Cura dei Disturbi dell’apprendimento e del Comportamento Associazione per la ricerca scientifica Fusis, Alvignano, Italy
| | - Maria Ruberto
- Department of Medical-Surgical and Dental Specialties, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Roberto Toraldo
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Marco Carotenuto
- Center for Childhood Headache, Clinic of Child and Adolescent Neuropsychiatry, Department of Mental and Physical Health, and Preventive Medicine, Università degli Studi della Campania “Luigi Vanvitelli”, Naples, Italy
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Biofeedback in the prophylactic treatment of medication overuse headache: a pilot randomized controlled trial. J Headache Pain 2016; 17:87. [PMID: 27655371 PMCID: PMC5031562 DOI: 10.1186/s10194-016-0679-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/13/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Medication overuse headache (MOH) is a major clinical concern and a common health risk. Recent literature stressed the need to manage chronic headache by using integrated biobehavioral approaches. Few studies evaluated how biofeedback can be useful in MOH. The aim of the study is to evaluate in a randomized, controlled, single-blind trial the effects of biofeedback associated with traditional pharmacological therapy in the prophylactic treatment of MOH. METHOD Twenty-seven subjects were randomized to frontal electromyographic (EMG) biofeedback associated with prophylactic pharmacological therapy (Bfb Group) or to pharmacological treatment alone (Control Group). The primary outcome was to evaluate the number of patients that return episodic after treatment. Secondly we evaluate the effects of frontal EMG BFB on frequency of headache and analgesic intake. Changes in coping strategies and in EMG frontalis tension were also evaluated. ANOVA was performed on all the variables of interest. RESULTS Our results indicate that at the end of treatment the number of patients that returned episodic in the Bfb group was significantly higher than in the Control group. Patients in the Bfb group differed from the Control group in headache frequency, amount of drug intake and active coping with pain. These outcomes were confirmed also after 4 months of follow-up. No significant effects were observed in EMG recordings. CONCLUSIONS Biofeedback added to traditional pharmacological therapy in the treatment of MOH is a promising approach for reducing headache frequency and analgesic intake. Modification of coping cognitions in the Bfb group, as an adjunct mechanism of self-regulation, needs more evaluations to understand the role of biofeedback in changing maladaptive psychophysiological responses.
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Psychological interventions for migraine: a systematic review. J Neurol 2016; 263:2369-2377. [PMID: 27159991 PMCID: PMC5110589 DOI: 10.1007/s00415-016-8126-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/08/2016] [Accepted: 04/09/2016] [Indexed: 11/02/2022]
Abstract
Migraine causes major health impairment and disability. Psychological interventions offer an addition to pharmacotherapy but they are not currently recommended by the National Institute of Clinical Excellence (NICE) or available in the National Health Service. We aimed to systematically review evidence on the efficacy of psychological interventions for migraine in adults. A search was done of MEDLINE, psychINFO, http://www.opengrey.eu , the meta-register of controlled trials and bibliographies. Twenty-four papers were included and rated independently by two people using the Yates scale, which has 35 points. Cochrane recommendations are that high quality reports score above the mid-point (18 points). Methods used in 17/24 papers were rated 'high quality'. However, frequently descriptions of key areas such as randomisation methods were omitted. Eighteen studies measured effects of psychological interventions on headache-related outcomes, fifteen reporting significant improvements, ranging 20-67 %. Interventions also produced improvements in psychological outcomes. Few trials measured or reported improvement in disability or quality of life. We conclude that evidence supports the efficacy of psychological interventions in migraine. Over half of the studies were from the USA, which did not provide universal health care at the time of the study, so it is difficult to generalise results to typical populations in receipt of publically funded health services. We agree with the NICE recommendation that high quality pragmatic randomised controlled trials are needed in the UK.
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The impact of regular lifestyle behavior in migraine: a prevalence case–referent study. J Neurol 2016; 263:669-76. [DOI: 10.1007/s00415-016-8031-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 01/03/2023]
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Ferrari A, Baraldi C, Sternieri E. Medication overuse and chronic migraine: a critical review according to clinical pharmacology. Expert Opin Drug Metab Toxicol 2015; 11:1127-44. [PMID: 26027878 DOI: 10.1517/17425255.2015.1043265] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Chronic migraine is often complicated by medication-overuse headache (MOH), a headache due to excessive intake of acute medications. Chronic migraine and MOH are serious and disabling disorders. Since chronic migraine derives from the progression of originally episodic migraine, the fundamental therapeutic strategy is prevention. This narrative review describes how to try to prevent the development of MOH and how to manage it once it has appeared. AREAS COVERED A PubMed database search (from 1988 to January 2015) and a review of published studies on chronic migraine and MOH were conducted. EXPERT OPINION In spite of progress in migraine treatment, the prevalence of chronic headaches and MOH has not changed in the course of time. Today, a large number of migraine patients have turned to numerous expert physicians and experienced all sorts of prophylactic treatments without decisive benefits. Their condition seems to have crystallized even more as chronic and intractable. This means that to prevent chronification and MOH, we need more effective drugs and better strategies to use them. In particular, we must detect disease biomarkers and predictive factors for drug response that allow for personalized treatment when migraine is still episodic and make analgesic overuse pointless.
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Affiliation(s)
- Anna Ferrari
- University of Modena and Reggio Emilia, Headache and Drug Abuse Research Centre, Department of Diagnostic, Clinical and Public Health Medicine , Via del Pozzo, 71 - 41124 Modena , Italy +39 05 9422 4064 ; +39 05 9422 4069 ;
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Kindelan-Calvo P, Gil-Martínez A, Paris-Alemany A, Pardo-Montero J, Muñoz-García D, Angulo-Díaz-Parreño S, La Touche R. Effectiveness of Therapeutic Patient Education for Adults with Migraine. A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PAIN MEDICINE 2014; 15:1619-36. [DOI: 10.1111/pme.12505] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Abstract
This review summarizes the various forms of behavioral treatment of migraine which could demonstrate empirical efficacy. The main unimodal kinds of treatment are thermal and electromyography (EMG) biofeedback training and progressive muscle relaxation. The various relaxation techniques do not differ in their efficacy in treating migraine. On average a reduction in migraine frequency of 35-45 % is achieved. The mean effect sizes (ES) of various biofeedback techniques are between 0.4 and 0.6. Cognitive-behavioral treatment is applied as a multimodal treatment and on average achieves an improvement in migraine activity by 39 % and an ES of 0.54. All behavioral procedures can be used in combination or as an alternative to drug prophylaxis with comparable success. A combination of pharmacological and behavioral treatment can achieve additional success. There is strong evidence for the clinically significant efficacy of all forms of behavioral treatment in childhood and adolescence. There are no signs of differential indications.
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Stevens J, Hayes J, Pakalnis A. A randomized trial of telephone-based motivational interviewing for adolescent chronic headache with medication overuse. Cephalalgia 2013; 34:446-54. [DOI: 10.1177/0333102413515336] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Nearly 2% of youths suffer from chronic migraine or chronic tension-type headache (CTTH). A contributing factor in approximately 20%–50% of these youths is medication overuse, which involves taking analgesics three or more times per week for three months. The objective of this study was to test motivational interviewing (MI) as an approach to promote adherence to recommendations regarding not only analgesic overuse but also other aspects of treatment plans. Methods A randomized controlled trial was conducted comparing the experimental condition (standard of care clinic-based treatment with supplemental MI phone calls; n = 24) to a control condition (standard of care clinic-based treatment without these supplemental MI phone calls; n = 23). Four months after enrollment, a research assistant who was blinded to study condition telephoned adolescents inquiring about headache frequency, headache severity, and disability. Results Headache frequency was lower in the experimental condition versus control condition for those with relatively lower initial levels of headache frequency. In contrast, we did not find greater improvement in headache severity and disability for the experimental condition relative to the control condition. Discussion Our findings provided some preliminary, albeit limited, support for MI as an approach to improve outcomes for adolescent medication-overuse headache (MOH).
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Sanmaneechai O, Ballaban-Gil K. Management of Headache in Children. Headache 2013. [DOI: 10.1002/9781118678961.ch22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Non-pharmacological approaches in migraine prophylaxis: behavioral medicine. Neurol Sci 2010; 31 Suppl 1:S133-5. [DOI: 10.1007/s10072-010-0306-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Saper JR, Lake AE, Bain PA, Stillman MJ, Rothrock JF, Mathew NT, Hamel RL, Moriarty M, Tietjen GE. A Practice Guide for Continuous Opioid Therapy for Refractory Daily Headache: Patient Selection, Physician Requirements, and Treatment Monitoring. Headache 2010; 50:1175-93. [DOI: 10.1111/j.1526-4610.2010.01733.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dodick DW. Review of comorbidities and risk factors for the development of migraine complications (infarct and chronic migraine). Cephalalgia 2010; 29 Suppl 3:7-14. [PMID: 20017749 DOI: 10.1177/03331024090290s303] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
A number of comorbid disorders, behavioural traits and associated risk factors in patients with migraine are known to increase the risk of complications such as ischaemic vascular events and chronic migraine, a syndrome that is more disabling and resistant to treatment with acute and preventative medications than episodic migraine. Reduction of cardiovascular risk factors, smoking cessation and use of non-oestrogen-containing oral contraceptives in female patients are beneficial strategies to reduce the risk of ischaemic events in patients with migraine (especially those with aura). Attack frequency, acute medication overuse, obesity and coexisting depression and anxiety disorders are particularly strong but potentially modifiable independent risk factors for progression to chronic migraine. Identifying and managing comorbidities and associated risk factors for complications of migraine are likely to require an integrated disease management strategy involving several disciplines and allied health services. Such a disease-oriented model of care may potentially interrupt the cycle of progression and disability and improve quality of life for patients with migraine.
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Affiliation(s)
- D W Dodick
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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Dodick DW. Review of comorbidities and risk factors for the development of migraine complications (infarct and chronic migraine). Cephalalgia 2009. [DOI: 10.1111/j.1468-2982.2009.02028.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Self-help group and medication overuse headache: preliminary data. Neurol Sci 2009; 30:459-63. [DOI: 10.1007/s10072-009-0131-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 08/21/2009] [Indexed: 10/20/2022]
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