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Ljubisavljevic S, Ljubisavljevic M, Damjanovic R, Kalinic S. A Descriptive Review of Medication-Overuse Headache: From Pathophysiology to the Comorbidities. Brain Sci 2023; 13:1408. [PMID: 37891777 PMCID: PMC10605322 DOI: 10.3390/brainsci13101408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE OF REVIEW Medication-overuse headache (MOH) is an important problem worldwide, with different areas of controversy regarding its entity. This article reviews the risk factors, comorbidities, pathophysiology, clinical presentation, effective management, and prognosis of MOH by summarizing and integrating the results and findings from previously performed more than 15,000 studies (from 2010 to 2023) available from the scientific database of the University Medical Library in the University Clinical Center of Niš, which aimed to investigate and define the complexity of this type of headache. RECENT FINDING It has been proposed that all acute migraine medications can lead to MOH, with differences in the propensity of different agents to cause the problem. Early data suggests that triptans and other painkillers used for the acute treatment of migraine may be an exception. Recent studies show that practitioners and the general public are still largely unaware of the problem of medication overuse and its damaging effects. SUMMARY Although it is likely that MOH does occur, restricting the number of acute medications is necessary to prevent it. It is also possible that increasing amounts of acute medications are simply a reflection of poorly controlled headaches rather than a cause. Further research needs to be developed to identify more precise mechanisms for effective MOH management and its evolution.
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Affiliation(s)
- Srdjan Ljubisavljevic
- Department for Neurology, University Clinical Centre of Nis, 18000 Nis, Serbia; (M.L.); (R.D.); (S.K.)
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Peck J, Zeien J, Patel M, Cornett EM, Berger AA, Hasoon J, Kassem H, Jung JW, Ramírez GF, Fugueroa PC, Singhal NR, Song J, Kaye AM, Kaye AD, Koushik SS, Strand NH, Ganti L. Review of Interventional Therapies for Refractory Pediatric Migraine. Health Psychol Res 2023; 10:67853. [PMID: 36726476 PMCID: PMC9886171 DOI: 10.52965/001c.67853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This is a review of the latest and seminal evidence in pediatric migraine. It covers the etiology and pathophysiology known today, and then will review treatment options, efficacy and safety, quality of data and indications. Though migraine is usually regarded as an infliction in adults, it is not uncommon in the pediatric population and affects up to 8% of children. Children may experience migraine differently than adults, and present not only with headache but also frequent gastrointestinal symptoms. They are frequently shorter in duration than in adults. Traditional migraine treatment in adults is less effective in children. In this population, adjunct therapies - such as interventional techniques - should be considered when traditional treatment fails, including Botulinum Toxin A (BTA) injections, peripheral nerve and ganglion blocks. BTA injections are FDA approved for migraine prophylaxis in adults, but currently not in children; however, recent evidence shows efficacy and safety in pediatric migraine management. Nerve blocks stop nociceptive afferent fibers through injection of local anesthetics, and it may be associated with the local injection of corticosteroids. Although more common in adults, recent data suggests they are safe and effective in children and adolescents. Blocking the sphenopalatine ganglion can be achieved through nasal approach, and achieves a similar action by blocking the entire ganglion. Interventional techniques may provide a key component in the alleviation of this otherwise debilitating chronic migraine pain. Though most studies have been performed in adults, new studies provide encouraging results for treatment in children.
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Affiliation(s)
| | - Justin Zeien
- Department of AnesthesiologyUniversity of Arizona College of Medicine-Phoenix
| | - Megha Patel
- Department of AnesthesiologyUniversity of Arizona College of Medicine-Phoenix
| | - Elyse M. Cornett
- Department of AnesthesiologyLouisiana State University Shreveport
| | | | - Jamal Hasoon
- Department AnesthesiologyMount Sinai Medical Center
| | - Hisham Kassem
- Department AnesthesiologyCritical Care, and Pain Medicine, Beth Israel Deaconess Medical Center
| | | | | | - Paola Colon Fugueroa
- NeurologyHCA Florida Osceola Hospital & University of Central Florida College if Medicine
| | - Neil R. Singhal
- Valley Anesthesiology and Pain Consultants – Envision Physician Services
| | | | - Adam M. Kaye
- Department of Pharmacy PracticeThomas J. Long School of Pharmacy and Health Sciences, University of the Pacific
| | - Alan D. Kaye
- Department of AnesthesiologyLouisiana State University Shreveport
| | - Sarang S. Koushik
- Valleywise Health Medical Center, Creighton University School of Medicine
| | - Natalie H. Strand
- Department of Anesthesiology and Perioperative MedicineMayo Clinic Phoenix
| | - Latha Ganti
- Neurology and Emergency MedicineUniversity of Central Florida College of Medicine
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3
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Abstract
Medication overuse headache (MOH) is a secondary headache disorder attributed to overuse of acute headache medications by a person with an underlying headache disorder, usually migraine or tension-type headache. MOH is common among individuals with 15 or more headache days per month. Although MOH is associated with substantial disability and reductions in quality of life, this condition is often under-recognized. As MOH is both preventable and treatable, it warrants greater attention and awareness. The diagnosis of MOH is based on the history and an unremarkable neurological examination, and is made according to the diagnostic criteria of the International Classification of Headache Disorders third edition (ICHD-3). Pathophysiological mechanisms of MOH include altered descending pain modulation, central sensitization and biobehavioural factors. Treatment of MOH includes the use of headache preventive therapies, but essential to success is eliminating the cause, by reducing the frequency of use of acute headache medication, and perhaps withdrawing the overused medication altogether. Appropriate treatment is usually highly effective, leading to reduced headache burden and acute medication consumption.
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Gibler RC, Knestrick KE, Reidy BL, Lax DN, Powers SW. Management of Chronic Migraine in Children and Adolescents: Where are We in 2022? Pediatric Health Med Ther 2022; 13:309-323. [PMID: 36110896 PMCID: PMC9470380 DOI: 10.2147/phmt.s334744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Migraine is a neurological disorder that affects millions of children and adolescents worldwide. Chronic migraine is a subtype of migraine in which patients experience headaches for more days than not each month, with accompanying symptoms of phonophobia, photophobia, nausea or vomiting for most of these headaches. The burden and impact of chronic migraine in the daily lives of children and adolescents is substantial, requiring a holistic, multidisciplinary, and biopsychosocial approach to conceptualization and treatment. The purpose of this review is to provide a comprehensive “2022” overview of acute and preventive treatments for the management of chronic migraine in youth. We first describe diagnostic criteria for chronic migraine and highlight the state of evidence for acute and preventive treatment in children and adolescents. We then discuss emerging treatments currently receiving rigorous clinical research effort, special considerations for the treatment of chronic migraine in children and adolescents, and avenues for improving existing treatments and expanding access to evidence-based care.
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Affiliation(s)
- Robert C Gibler
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Correspondence: Robert C Gibler, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, Email
| | - Kaelynn E Knestrick
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Brooke L Reidy
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Daniel N Lax
- Division of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Scott W Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
- Headache Center, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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5
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Kaltseis K, Frank F, Bernar B, Kiechl S, Winder B, Kiechl-Kohlendorfer U, Knoflach M, Broessner G. Primary headache disorders in adolescents in North- and South-Tyrol: Findings of the EVA-Tyrol-Study. Cephalalgia 2022; 42:993-1004. [PMID: 35331020 PMCID: PMC9442274 DOI: 10.1177/03331024221088997] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Assessment of the prevalence of primary headache disorders, associated risk factors and use of acute/preventive medication in a representative large sample of adolescents. METHODS Within the EVA-Tyrol project, a community-based non-randomized controlled cross-sectional study, data was collected from adolescents aged 14-19 years from 45 sites across North-, East- and South Tyrol. Headaches were classified according to the latest ICHD-3 and assessed by headache specialists in face-to-face interviews. FINDINGS Of 1923 participants 930 (48.4%) reported having headaches. Female to male ratio was 2:1. Migraine, tension-type headache and other headache were diagnosed in 10%, 30.2% and 8.2% respectively. Medication overuse was diagnosed in 3.4%, increasing up to 21.7% in participants with chronic headache. The use of preventative medication was not reported by any adolescent. Sleep disturbances (p < 0.05), alcohol consumption (p < 0.05), low physical activity (p < 0.01) and high screen time exposure (p < 0.01) were associated with an increased risk of headaches. CONCLUSION We report high prevalence of primary headache disorders and medication overuse in a large community-based sample of teenagers. Acute and preventive non-drug and pharmacological treatments are not established due to lack of paediatric headache outpatient clinics. Promoting health education in teenagers and encouraging public awareness, including that of health care providers is pivotal.Trial registration: EVA-Tyrol has been retrospectively registered at clinicaltrials.gov under https://clinicaltrials.gov/ct2/show/NCT03929692 since April 29, 2019.
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Affiliation(s)
- Katharina Kaltseis
- Department of Neurology, Medical University of Innsbruck,
Innsbruck, Austria
| | - Florian Frank
- Department of Neurology, Medical University of Innsbruck,
Innsbruck, Austria
| | - Benoît Bernar
- Department of Paediatrics I, Medical University of Innsbruck,
Innsbruck, Austria
| | - Sophia Kiechl
- Department of Neurology, Medical University of Innsbruck,
Innsbruck, Austria,VASCage, Research Centre on Vascular Ageing and Stroke,
Innsbruck, Austria
| | - Bernhard Winder
- VASCage, Research Centre on Vascular Ageing and Stroke,
Innsbruck, Austria,Department of Paediatrics II, Medical University of Innsbruck,
Innsbruck, Austria
| | - Ursula Kiechl-Kohlendorfer
- VASCage, Research Centre on Vascular Ageing and Stroke,
Innsbruck, Austria,Department of Paediatrics II, Medical University of Innsbruck,
Innsbruck, Austria
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck,
Innsbruck, Austria,VASCage, Research Centre on Vascular Ageing and Stroke,
Innsbruck, Austria
| | - Gregor Broessner
- Department of Neurology, Medical University of Innsbruck,
Innsbruck, Austria,Gregor Broessner, Department of Neurology,
Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria.
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Shinde N, Kanabar DJ, Miles LJ. Narrative review of the prevalence and distribution of acute pain in children in the self-care setting. PAEDIATRIC & NEONATAL PAIN 2022; 4:169-191. [PMID: 36618510 PMCID: PMC9798044 DOI: 10.1002/pne2.12085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 05/16/2022] [Accepted: 07/20/2022] [Indexed: 01/11/2023]
Abstract
Acute pain among children is common, yet it may be underestimated and undertreated if the pain is not recognized. Assessing and managing pediatric pain can be complicated, and as such, measuring the prevalence of acute pain in children can be challenging. We sought to provide a consolidated review of the available data on the prevalence of commonly occurring acute pain in children in the self-care setting. An extensive literature search was performed to determine the prevalence of acute pain at multiple bodily locations in children aged between 3 months and 18 years. We considered the influence of age, sex, and sociodemographic factors on prevalence estimates. We also sought to identify some of the challenges involved in assessing and managing pediatric pain, thus shedding light on areas where there may be clinical and medical unmet needs. In general, a high prevalence of acute pain in children was detected, particularly headache, menstruation-related pain, and dental and back pain. Older age, female sex, and lower socioeconomic status were associated with increased pain prevalence. Risk factors were identified for all pain types and included psychological issues, stress, and unhealthy lifestyle habits. Owing to the heterogeneity in study populations, the prevalence estimates varied widely; there was also heterogeneity in the pain assessment tools utilized. The paucity of information regarding pain prevalence appears to be out of proportion with the burden of acute pain in children. This could indicate that clinicians may not be equipped with an optimal pain management strategy to guide their practice, especially regarding the use of developmentally appropriate pain assessment tools, without which prevalence data may not be captured. If acute pain is not accurately identified, it cannot be optimally treated. Further investigation is required to determine how the information from prevalence studies translates to the real-world setting.
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Affiliation(s)
- Nutan Shinde
- Reckitt Benckiser plc (Global Headquarters)BerkshireUK
| | | | - Lisa J. Miles
- Reckitt Benckiser plc (Global Headquarters)BerkshireUK
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Pediatric Headache in Primary Care and Emergency Departments: Consensus with RAND/UCLA Method. Life (Basel) 2022; 12:life12020142. [PMID: 35207430 PMCID: PMC8877535 DOI: 10.3390/life12020142] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 01/09/2023] Open
Abstract
Headache is the most frequent neurological symptom in childhood and the main reason for admission to pediatric emergency departments. The aim of this consensus document is to define a shared clinical pathway between primary care pediatricians (PCP) and hospitals for the management of children presenting with headache. For the purposes of the study, a group of hospital pediatricians and a group of PCP from the Emilia Romagna’s health districts were selected to achieve consensus using the RAND/UCLA appropriateness method. Thirty-nine clinical scenarios were developed: for each scenario, participants were asked to rank the appropriateness of each option from 1 to 9. Agreement was reached if ≥75% of participants ranked within the same range of appropriateness. The answers, results, and discussion helped to define the appropriateness of procedures with a low level of evidence regarding different steps of the diagnostic-therapeutic process: primary care evaluation, emergency department evaluation, hospital admission, acute therapy, prophylaxis, and follow-up. The RAND proved to be a valid method to value appropriateness of procedures and define a diagnostic-therapeutic pathway suitable to the local reality in the management of pediatric headache. From our results, some useful recommendations were developed for optimizing the healthcare professionals’ network among primary care services and hospitals.
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8
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Over-the-counter analgesics use is associated with pain and psychological distress among adolescents: a mixed effects approach in cross-sectional survey data from Norway. BMC Public Health 2021; 21:2030. [PMID: 34742281 PMCID: PMC8572415 DOI: 10.1186/s12889-021-12054-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over-the-counter analgesics (OTCA) such as Paracetamol and Ibuprofen are frequently used by adolescents, and the route of administration and access at home allows unsupervised use. Psychological distress and pain occur simultaneously and are more common among females than among males. There is a dynamic interplay between on-label pain indications and psychological distress, and frequent OTCA use or misuse can exacerbate symptoms. No studies have to date provided an overview of frequent OTCA use in a larger population-based study. The current study used survey data to explore associations between and the relative predictive value of on-label pain indication and measures of psychological distress, together with sex differences for weekly OTCA use. METHODS This study included 349,528 adolescents aged 13-19. The data was collected annually between January 2014 and December 2018 as part of the Norwegian Young Data survey. Performance analysis was conducted to explore the relative roles and associations between on-label pain indication and psychological distress in weekly OTCA use. A mixed-effects logistic regression model was used to explore the unique contributions from four domains of on-label pain indication and psychological distress as measured by a combined measure of anxiety and depression (HSCL-10) and peer-bullying involvement as victims or bullies. RESULTS Thirty percent of females and 13 % of males use OTCA weekly. Headache is the strongest on-label pain predictor of weekly OTCA use, followed by abdominal pain. Depression and anxiety are the strongest psychological predictor of weekly OTCA use, and higher symptom levels and being female increase the strength of this association. Anxiety and depression also predict weekly OTCA use after controlling for physiological pain. CONCLUSIONS Sex, pain and anxiety and depression are inter-correlated and strong predictors of frequent OTCA use. Frequent OTCA use in the context of psychological distress may be a form of self-medication that can exacerbate symptoms and decrease psychosocial function. Longitudinal studies that explore causal trajectories between frequent on-label OTCA use and psychological distress are required. OTCA use among adolescents, and particularly among females, with anxiety and depression should be administered with caution and closely monitored.
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9
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Shapiro HF, Lebel A. Pediatric Episodic Migraine with Aura: A Unique Entity? CHILDREN-BASEL 2021; 8:children8030228. [PMID: 33802676 PMCID: PMC8002456 DOI: 10.3390/children8030228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/16/2022]
Abstract
Migraine headache is a common cause of pain and disability in children and adolescents and is a major contributor to frequently missed school days and limitations in activities. Of children and adolescents with migraine headache, approximately one-third have migraine with aura (MA). MA is often considered to be similar to migraine without aura (MO), and thus, many studies do not stratify patients based on the presence of aura. Because of this, treatment recommendations are often analogous between MA and MO, with a few notable exceptions. The purpose of this review is to highlight the current evidence demonstrating the unique pathophysiology, clinical characteristics, differential diagnosis, co-morbidities, and treatment recommendations and responses for pediatric MA.
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Affiliation(s)
- Hannah F.J. Shapiro
- Department of Child Neurology, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Boston Children’s Hospital, Boston, MA 02115, USA
- Correspondence:
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10
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Pohl H, Do TP, García-Azorín D, Hansen JM, Kristoffersen ES, Nelson SE, Obermann M, Sandor PS, Schankin CJ, Schytz HW, Sinclair A, Schoonman GG, Gantenbein AR. Green Flags and headache: A concept study using the Delphi method. Headache 2021; 61:300-309. [PMID: 33405273 DOI: 10.1111/head.14054] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/11/2020] [Accepted: 11/30/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to collect and rate Green Flags, that is, symptoms or pieces of information indicating that a patient is more likely to suffer from a primary than from a secondary headache. BACKGROUND When assessing headaches, a central question to be answered is whether the pain is primary or secondary to another disorder. To maximize the likelihood of a correct diagnosis, relevant signs and symptoms must be sought, identified, and weighed against each other. METHODS The project was designed as a Delphi study. In the first round, an expert panel proposed green flags that were rated anonymously in two subsequent rounds. Proposals with an average rating of 4.0 and higher on a scale from 0 to 5 reached consensus. RESULTS Five Green Flags reached consensus: (i) "The current headache has already been present during childhood"; (ii) "The headache occurs in temporal relationship with the menstrual cycle"; (iii) "The patient has headache-free days"; (iv) "Close family members have the same headache phenotype"; and (v) "Headache occurred or stopped more than one week ago." CONCLUSIONS We propose five Green Flags for primary headache disorders. None being a pathognomonic sign, we recommend searching for both Green Flags and Red Flags. If both are present, a secondary headache should be suspected. Overall, the application of the Green Flag concept in clinical practice is likely to increase diagnostic accuracy and improve diagnostic resource allocation. Prospective studies in clinical populations should be conducted to validate these Green Flags.
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Affiliation(s)
- Heiko Pohl
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Thien Phu Do
- The Danish Headache Center, Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Jakob Møller Hansen
- The Danish Headache Center, Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - Espen Saxhaug Kristoffersen
- Department of Neurology, Akershus University Hospital, Oslo, Norway.,Department of General Practice, University of Oslo, Oslo, Norway
| | - Sarah E Nelson
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Mark Obermann
- Center for Neurology, Asklepios Hospitals Schildautal, Seesen, Germany.,Department of Neurology, University of Duisburg-Essen, Essen, Germany
| | - Peter S Sandor
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Departement of Neurology and Neurorehabilitation, RehaClinic Group, Bad Zurzach, Switzerland
| | - Christoph J Schankin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Henrik Winther Schytz
- The Danish Headache Center, Rigshospitalet-Glostrup, Faculty of Health Sciences, University of Copenhagen, Glostrup, Denmark
| | - Alexandra Sinclair
- Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Guus G Schoonman
- Department of Neurology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | - Andreas R Gantenbein
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland.,Departement of Neurology and Neurorehabilitation, RehaClinic Group, Bad Zurzach, Switzerland
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Moavero R, Stornelli M, Papetti L, Ursitti F, Ferilli MAN, Balestri M, Sforza G, Tarantino S, Vigevano F, Valeriani M. Medication Overuse Withdrawal in Children and Adolescents Does Not Always Improve Headache: A Cross-Sectional Study. Front Neurol 2020; 11:823. [PMID: 32973650 PMCID: PMC7466727 DOI: 10.3389/fneur.2020.00823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022] Open
Abstract
Background: MOH can be diagnosed in subjects with headache occurring 15 days/month in association with a regular medication overuse, but its existence is not universally accepted. ICHD-3 redefined criteria for MOH, removing the criterion associating drug suspension with headache course. The aim of our study was to compare the rate of patients diagnosed with medication overuse headache (MOH) according to ICHD-2 and ICHD-3 criteria, to verify the degree of concordance. The secondary aim was to verify if drug withdrawal was really associated with pain relief. Methods: In this cross-sectional study, we retrospectively analyzed a sample of 400 patients followed for primary chronic headache at the Headache Center of Bambino Gesù Children's Hospital. We then selected those presenting with a history of medication overuse, and we applied both ICHD-2 and ICHD-3 criteria to verify in which patients the criteria would identify a clinical diagnosis of MOH. Results: We identified 42 subjects (10.5%) with MOH; 23 of them (55%) presented a relief of headache withdrawing drug overuse. Regarding the applicability of the ICHD-2 criteria, 43% of patients (18/42) fulfilled all criteria, while all ICHD-3 diagnostic criteria were satisfied in 76% of patients (32/42). Eighteen patients (43%) satisfied both ICHD-2 and ICHD-3 criteria, while 10 patients (24%) did not satisfy either diagnostic criterion. Conclusions: Our study suggests that in children and adolescents, withdrawing medication overuse is not always associated with a clinical benefit. Therefore, though allowing a MOH diagnosis in a higher rate of patients as compared to ICHD-2, the application of ICHD-3 criteria does not guarantee a true a causal relationship between medication overuse and headache worsening.
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Affiliation(s)
- Romina Moavero
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Maddalena Stornelli
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Laura Papetti
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabiana Ursitti
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Michela Ada Noris Ferilli
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Martina Balestri
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Giorgia Sforza
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Rome, Italy
| | - Samuela Tarantino
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Federico Vigevano
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimiliano Valeriani
- Child Neurology Unit, Neuroscience and Neurorehabilitation Department, Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,Center for Sensory Motor Interaction, Aalborg University, Aalborg, Denmark
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12
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Connelly M, Bickel J. Primary Care Access to an Online Decision Support Tool is Associated With Improvements in Some Aspects of Pediatric Migraine Care. Acad Pediatr 2020; 20:840-847. [PMID: 31809810 DOI: 10.1016/j.acap.2019.11.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/18/2019] [Accepted: 11/28/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate whether primary care provider (PCP) access to an online decision support tool is associated with a change in evidence-based primary care medical management of pediatric migraine. METHODS In this prospective observational study, PCPs serving a target community were educated on the availability and use of an online clinical decision support tool that was developed to inform treatment of pediatric migraine. For 9 months before and after implementation of the decision tool, the proportions of children with migraine prescribed evidence-based and contraindicated medications by PCPs in the target region were monitored using electronic medical record query and statistically compared to these same proportions for patients in surrounding (control) regions. Rates of visits to the emergency department for migraine also were tracked pre- and postimplementation as an indirect measure of impact of the decision tool. Provider usage of the decision tool was monitored and summarized using web analytics. RESULTS Approximately half (56%) of target region PCPs used the online tool at least once over the project period. Relative to control regions and baseline trends, the proportion of children residing in the target region who were prescribed recommended abortive and preventive medications for treating migraine was statistically significantly higher following implementation of the tool. No significant changes to frequency of emergency care visits for migraine by youth in the target region were observed. CONCLUSIONS Availability to PCPs of an online decision support tool for pediatric migraine is associated with a modest change in some aspects of evidence-based medical care.
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Affiliation(s)
- Mark Connelly
- Division of Developmental and Behavioral Health (M Connelly), Children's Mercy Kansas City, Kansas City, MO.
| | - Jennifer Bickel
- Division of Neurology (J Bickel), Children's Mercy Kansas City, Kansas City, MO.
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Kamath A, Shetty J. Are alternative and complementary therapies effective for tension-type headaches in children? Arch Dis Child 2020; 105:802-804. [PMID: 32561544 DOI: 10.1136/archdischild-2020-319303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/01/2020] [Accepted: 06/03/2020] [Indexed: 01/05/2023]
Affiliation(s)
| | - Jayakara Shetty
- Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK .,Division of Health Sciences, University of Edinburgh, Edinburgh, UK
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14
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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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Abstract
Pediatric primary headache disorders are best treated using a comprehensive and integrative approach, due to the complex interactions between psychosocial and biological processes. Although more quality research is needed for treatment approaches to pediatric headaches, current practice management includes both pharmaceutical and nonpharmaceutical management. This article describes the integrative treatments used in a large regional pediatric headache program. Lifestyle approaches, nutraceuticals and dietary supplements, acupuncture, transcutaneous neurostimulation, relaxation, clinical hypnosis, biofeedback, and psychological services are discussed in detail for clinicians who may consider applying to their practice. [Pediatr Ann. 2019;48(6):e231-e235.].
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Connelly M, Sekhon S. Current perspectives on the development and treatment of chronic daily headache in children and adolescents. Pain Manag 2019; 9:175-189. [PMID: 30681030 DOI: 10.2217/pmt-2018-0057] [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] [Indexed: 12/12/2022] Open
Abstract
Headache disorders subsumed under the term chronic daily headache (CDH), including chronic migraine, chronic tension-type headache and new daily persistent headache, affect up to 4% of the pediatric population and can be highly disabling and challenging to effectively treat. Although historically the knowledge base about this group of headache disorders in children primarily was derived from clinical observation and extrapolation from adult studies, over the past several years there have been important research findings relevant to the development and management of pediatric CDH that can help inform clinical practice. The intent of this paper is to provide a focused review on recent empirical work done on pediatric CDH and suggest avenues for future work.
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Affiliation(s)
- Mark Connelly
- Department of Pediatrics, Division of Developmental and Behavioral Sciences, Children's Mercy Hospitals & Clinics, 2401 Gillham Road, Kansas City, MO 64108, USA
| | - Subhjit Sekhon
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64110, USA
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Abstract
PURPOSE OF REVIEW Headaches in children and adolescents are common, causing debilitating symptoms in many. Treatment of headache disorders can be complex and standard lifestyle changes as well as oral medications may offer inadequate relief. The purpose of this article is to review the mechanism of action, efficacy and technique of peripheral nerve blocks (PNBs) and the role they play in treating paediatric headache disorders. RECENT FINDINGS Evidence for the use of PNBs in youth is limited. However, available studies show evidence of benefit in both primary and secondary headache disorders. Variability exists in the type of block, medication choice, volume infused and frequency of this treatment. There are no serious side effects associated with PNBs. SUMMARY PNBs are well tolerated and effective as adjunctive therapy for many disabling paediatric headache disorders. The technique can be easily learned by frontline and specialty practitioners. Prospective placebo-controlled studies are needed to determine how to best maximize PNBs for headache management (i.e. medication choice, timing and so on).
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Bermúdez Salazar M, Rojas Cerón CA, Arana Muñoz RS. Prophylaxis with melatonin for primary stabbing headache in pediatrics: a case report. Colomb Med (Cali) 2018; 49:244-248. [PMID: 30410200 PMCID: PMC6220483 DOI: 10.25100/cm.v49i2.3857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Primary stabbing headache (or "ice pick headache") is an alteration characterized by brief jabs (short stabs of pain, lasting ~3 seconds), which appear spontaneously, irregularly, and affecting unilaterally or bilaterally. Indomethacin has traditionally been used as the main therapeutic option. However, this drug is ineffective in a considerable percentage of patients and can generate multiple adverse effects that occur at therapeutic doses. CLINICAL CASE A 7-year-old male patient with primary stabbing headache of mild to moderate intensity, lasting 3 to 4 seconds, without relevant history, with normal neurodevelopment, neurological examination and neuroimaging; no triggers were identified. It was started therapeutic trial with Coenzyme Q10; however, no improvement in the symptoms was identified. TREATMENT AND OUTCOMES A therapeutic management was carried out with Melatonin, which led to complete remission of the symptoms; without adverse effects in the posterior follow-up months. CLINICAL AND SCIENTIFIC RELEVANCE There is little information regarding effective and safe treatments for primary stabbing headache in children. The present case identifies Melatonin as an innovative, effective and safe therapeutic alternative in the treatment of primary stabbing headache in children. This is a significant advance in the understanding of primary stabbing headache in the pediatric population. CONCLUSION Melatonin may be an effective and safe therapeutic option for the treatment of primary stabbing headache in pediatric patients. It is necessary to deepen its research, in order to establish its use in a clinical practice guide.
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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: 73] [Impact Index Per Article: 12.2] [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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Affiliation(s)
| | - Christina L. Szperka
- Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia
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Abstract
PURPOSE OF REVIEW Headache phenotypes can differ between adults and children. While most headaches are due to primary headache disorders, in a small population, they can be an indication of a potentially life-threatening neurologic condition. The challenge lies in identifying warning signs that warrant further workup. This article reviews different types of pediatric headaches and headache evaluation in children and teens, and focuses on the approach for diagnosis of secondary headaches. RECENT FINDINGS Common thought is that increased frequency and severity of headache may reflect secondary pathology; however, headache phenotype may not be fully developed and can evolve in adolescence or adulthood. Headache location, particularly occipital headache alone, does not necessarily signify secondary intracranial pathology. Certain warning signs warrant neuroimaging, but others only warrant imaging in certain clinical contexts. Brain MRI is the neuroimaging modality of choice, though there is a high rate of incidental findings and often does not change headache management. A stepwise approach is essential to avoid missing secondary headaches. There are several differences between adults and children in clinical manifestations of headache. Evaluation and diagnosis of pediatric headache starts with a thorough headache and medical history, family and social history, and identification of risk factors. A thorough physical and neurologic exam is important, with close attention to features that could suggest secondary headache pathology. Neuroimaging and other testing should only be performed if there is concern for secondary headache.
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22
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Connelly M, Bickel J, Wingert T, Galemore C. The Headache Action Plan Project for Youth (HAPPY): School Nurses as Facilitators of System Change in Pediatric Migraine Care. NASN Sch Nurse 2018; 33:40-47. [PMID: 28777680 DOI: 10.1177/1942602x17719300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Migraine is a common health problem in youth that is ranked highest for disability among neurological conditions and is one of the leading reasons for school absences. Children with migraines frequently are seen by the school nurse for care, sometimes before ever being seen by another healthcare provider for evaluation and treatment. As such, school nurses have the unique opportunity to provide education and resources to children with migraines and their family. This article provides information on the Headache Action Plan Program for Youth (HAPPY), a project involving the provision of live and online migraine education and management resources to school nurses, children, families, and primary care providers in an effort to improve migraine recognition and care in the community.
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Affiliation(s)
| | - Jennifer Bickel
- Medical Director and Chief of the Headache Section in Neurology, Kansas City, MO
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23
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Özge A, Abu-Arafeh I, Gelfand AA, Goadsby PJ, Cuvellier JC, Valeriani M, Sergeev A, Barlow K, Uludüz D, Yalın OÖ, Faedda N, Lipton RB, Rapoport A, Guidetti V. Experts' opinion about the pediatric secondary headaches diagnostic criteria of the ICHD-3 beta. J Headache Pain 2017; 18:113. [PMID: 29285571 PMCID: PMC5745369 DOI: 10.1186/s10194-017-0819-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 11/09/2017] [Indexed: 12/12/2022] Open
Abstract
Background The 2013 International Classification of Headache Disorders-3 was published in a beta version to allow clinicians to confirm the validity of the criteria or suggest improvements based on field studies. The aim of this work was to review the Secondary Headache Disorders and Cranial Neuralgias and Other Headache Disorders sections of ICHD-3 beta data on children and adolescents (age 0–18 years) and to suggest changes, additions, and amendments. Methods Several experts in childhood headache across the world applied different aspects of ICHD-3 beta in their normal clinical practice. Based on their personal experience and the available literature on pediatric headache, they made observations and proposed suggestions for the mentioned headache disorders on children and adolescents. Results Some headache disorders in children have specific features, which are different from adults that should be acknowledged and considered. Some features in children were found to be age-dependent: clinical characteristics, risks factors and etiologies have a strong bio psychosocial basis in children and adolescents making primary headache disorders in children distinct from those in adults. Conclusions Several recommendations are presented in order to make ICHD-3 more appropriate for use in children.
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Affiliation(s)
- Aynur Özge
- Department of Neurology, Mersin University Medical Faculty, Mersin, Turkey
| | | | - Amy A Gelfand
- UCSF Headache Center and UCSF Benioff Children's Hospital Pediatric Brain Center 2330 Post St, 6th Floor, Campus Box 1675, San Francisco, CA, 94115, USA
| | - Peter James Goadsby
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
| | - Jean Christophe Cuvellier
- Division of Paediatric Neurology, Department of Paediatrics, Lille Faculty of Medicine and Children's Hospital, Lille, France
| | - Massimiliano Valeriani
- Division of Neurology, Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Rome, Italy.,Center for Sensory-Motor Interaction Aalborg University, Aalborg, Denmark
| | - Alexey Sergeev
- Department of Neurology and Clinical Neurophysiology, University Headache Clinic, Moscow State Medical University, Moscow, Russia
| | - Karen Barlow
- Faculty of Medicine, University of Calgary, Alberta Children's Hospital, C4-335, 2888 Shaganappi Trail NW, Calgary, AB, T3B 6A8, Canada
| | - Derya Uludüz
- Cerrahpaşa Medical Faculty, Deaprtment of Neurology, İstanbul University, Kocamustafapaşa, İstanbul, Turkey
| | - Osman Özgür Yalın
- İstanbul Research and Education Hospital, Kocamustafapaşa, İstanbul, Turkey
| | - Noemi Faedda
- Phd program in Behavioural Neuroscience, Department of Paediatrics and Child and Adolescent Neuropsychiatry, Sapienza University of Rome, Rome, Italy
| | - Richard B Lipton
- Department of Psychiatry and Behavioral Sciences, Department of Epidemiology & Population Health, Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alan Rapoport
- The David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vincenzo Guidetti
- Department of Pediatrics and Child and Adolescent Neuropsychiatry, Sapienza University, Rome, Italy.
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Faber AJ, Lagman-Bartolome AM, Rajapakse T. Drugs for the acute treatment of migraine in children and adolescents. Paediatr Child Health 2017; 22:454-458. [PMID: 29479263 DOI: 10.1093/pch/pxx170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
| | | | - Thilinie Rajapakse
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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25
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Westergaard ML, Munksgaard SB, Bendtsen L, Jensen RH. Medication-overuse headache: a perspective review. Ther Adv Drug Saf 2016; 7:147-58. [PMID: 27493718 DOI: 10.1177/2042098616653390] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Medication-overuse headache (MOH) is a debilitating condition in which frequent and prolonged use of medication for the acute treatment of pain results in the worsening of the headache. The purpose of this paper is to review the most recent literature on MOH and discuss future avenues for research. MOH accounts for a substantial share of the global burden of disease. Prevalence is often reported as 1-2% but can be as high as 7% overall, with higher proportions among women and in those with a low socioeconomic position. Management consists of withdrawing pain medication, focusing on prophylactic and nonmedical treatments, and limiting acute symptomatic medication. Stress reduction and lifestyle interventions may support the change towards rational pain medication use. Support, follow up, and education are needed to help patients through the detoxification period. There is fertile ground for research in MOH epidemiology, pathophysiology, and neuroimaging. Randomized and long-term follow-up studies on MOH treatment protocols are needed. Further focused research could be of major importance for global health.
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Affiliation(s)
- Maria Lurenda Westergaard
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Nordre Ringvej 67, Område Nord Bygning 14, 2600 Glostrup, Denmark
| | - Signe Bruun Munksgaard
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Lars Bendtsen
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Rigshospitalet - Glostrup, University of Copenhagen, Glostrup, Denmark
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Markus TE, Moad B, Haimi-Cohen Y, Zeharia A. Factors Influencing Response to Pharmacologic Treatment of Migraine in a Pediatric Headache Clinic. Headache 2016; 56:1120-31. [DOI: 10.1111/head.12858] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 04/11/2016] [Accepted: 04/11/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Tal Eidlitz Markus
- Day Hospitalization Department; Pediatric Headache Clinic; Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Bder Moad
- Day Hospitalization Department; Pediatric Headache Clinic; Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Yishai Haimi-Cohen
- Day Hospitalization Department; Pediatric Headache Clinic; Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - Avraham Zeharia
- Day Hospitalization Department; Pediatric Headache Clinic; Schneider Children's Medical Center of Israel, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
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