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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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Arab A, Khoshbin M, Karimi E, Saberian G, Saadatnia M, Khorvash F. Effects of greater occipital nerve block with local anesthetic and triamcinolone for treatment of medication overuse headache: an open-label, parallel, randomized, controlled clinical trial. Neurol Sci 2021; 43:549-557. [PMID: 33945036 DOI: 10.1007/s10072-021-05295-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
AIM There is a paucity of evidence and consensus on exactly how to carry out the detoxification process. To examine the effect of a greater occipital nerve block (GONB) in the detoxification process, we conducted an open-label, parallel, randomized, controlled clinical trial. MATERIALS AND METHODS In order to conduct this study, 54 medication-overuse headache (MOH) patients were recruited and allocated randomly to group A (n = 27) or B (n = 27). In both groups, patients underwent detoxification processes without any acute migraine medication or analgesics. During the run-in period, all patients in both groups received the same education, managed by a neurologist and nutritionist. All patients were offered maximally 300 mL of promethazine syrup (5 mg/5 mL) to be taken 10 mg every 8 h during the first 10 days of the study. A 2-mL syringe containing 1 mL of lidocaine 2% and 1 mL of triamcinolone 40 mg/mL was prepared for each patient of group A for conducting GONB. Characteristics of headache attacks, including headache severity, frequency, and duration, were assessed at baseline and after 3 months of intervention. RESULTS Twenty-six patients in group A (96.3%) and twenty-three in group B (85.2%) completed detoxification, and were thus cured of MOH (P = 0.351). The present study revealed that GONB with local anesthetic and triamcinolone significantly improved the characteristics of headache, including frequency (- 13.66 in group A and - 7.55 in group B), duration (- 7.92 in group A and - 5.88 in group B), and severity (- 3.44 in group A vs. - 1.33 in group B) in group A compared to control (all P value < 0.05). CONCLUSIONS Although both detoxification programs were effective, detoxification with GONB resulted in better outcomes. TRIAL REGISTRATION Iranian Registry of Clinical Trials (registration number; IRCT20150906023922N2).
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Affiliation(s)
- Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Khoshbin
- Anesthesia and Critical Care Department, Shah Vali Hospital, Azad University of Medical Science, Yazd, Iran
| | - Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazal Saberian
- School of Medicine, Azad University of Medical Science, Yazd, Iran
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Center, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Al Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
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Grazzi L, Usai S, Bolognini N, Grignani E, Sansone E, Tramacere I, Maravita A, Lauria G. No efficacy of transcranial direct current stimulation on chronic migraine with medication overuse: A double blind, randomised clinical trial. Cephalalgia 2020; 40:1202-1211. [DOI: 10.1177/0333102420931050] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Transcranial direct current stimulation was suggested to provide beneficial effects in chronic migraine, a condition often associated with medication overuse for which no long-term therapy is available. Methods We conducted a randomised controlled trial to assess long-term efficacy of transcranial direct current stimulation. Adults diagnosed with chronic migraine and medication overuse were assigned to receive in a 1:1:1 ratio anodal, cathodal, or sham transcranial direct current stimulation daily for five consecutive days, along with standardised drug withdrawal protocol. Primary outcome was 50% reduction of days of headache per month at 12 months. Co-secondary outcomes were 50% reduction of days of headache per month at 6 months, reduction of analgesic intake per month, and change in disability and quality of life, catastrophising, depression, state and trait anxiety, dependence attitude and allodynia intensity. Patients were not allowed to take any migraine prophylaxis drug for the entire study period. Results We randomly allocated 135 patients to anodal (44), cathodal (45), and sham (46) transcranial direct current stimulation. At 6 and 12 months, the percentage of reduction of days of headache and number of analgesics per month ranged between 48.5% and 64.7%, without differences between transcranial direct current stimulation (cathodal, anodal, or the results obtained from the two arms of treatment, anodal plus cathodal) and sham. Catastrophising attitude significantly reduced at 12 months in all groups. There was no difference for the other secondary outcomes. Conclusions Transcranial direct current stimulation did not influence the short and long-term course of chronic migraine with medication overuse after acute drug withdrawal. Behavioral and educational measures and support for patients’ pain management could provide long-term improvement and low relapse rate. Trial registration number NCT04228809
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Affiliation(s)
- Licia Grazzi
- Neuroalgology Unit, Headache Centre, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Susanna Usai
- Neuroalgology Unit, Headache Centre, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Nadia Bolognini
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Neuropsychology Laboratory, Milan, Italy
| | - Eleonora Grignani
- Neuroalgology Unit, Headache Centre, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Emanuela Sansone
- Neuroalgology Unit, Headache Centre, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Angelo Maravita
- Department of Psychology and Milan Center for Neuroscience, University of Milano-Bicocca, Milan, Italy
| | - Giuseppe Lauria
- Neuroalgology Unit, Headache Centre, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy
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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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D'Amico D, Sansone E, Grazzi L, Giovannetti AM, Leonardi M, Schiavolin S, Raggi A. Multimorbidity in patients with chronic migraine and medication overuse headache. Acta Neurol Scand 2018; 138:515-522. [PMID: 30107027 DOI: 10.1111/ane.13014] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/01/2018] [Accepted: 08/10/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Patients with chronic migraine (CM) display a considerable amount of comorbidities, particularly psychiatric and cardiovascular, and the presence of multiple comorbidities, that is, the so-called multimorbidity, is a risk factor for migraine chronification or maintenance of CM. Our aim was to address the rate and impact of multimorbidity in patients with CM and medication overuse headache (MOH). MATERIALS & METHODS In a sample of patients with CM attending a structured withdrawal for coexisting MOH, we defined multimorbidity as the presence of two or more conditions in addition to CM-MOH. We compared patients with and without multimorbidity for demographic and clinical variables, quality of life, and disability; we also tested whether patients with multimorbidity had higher likelihood to attend emergency room, relapse into CM, and require further withdrawal treatments by 12 months. RESULTS One hundred and ninety-four patients were enrolled as follows: 61% had at least one comorbidity, the most common being mental (34%), circulatory (18%), and endocrine conditions (13%); 32% were multimorbidity cases. Patients with multimorbidity had higher headaches frequency, older age, lower education and lower employment rates, higher disability and lower QoL. They were more frequently opioids/barbiturates overusers and were more likely to attend ER (OR: 2.36), relapse into CM (OR: 2.19), and undergo another withdrawal (OR: 2.75) by 12 months after discharge, after controlling for age, gender, years of education, and headache frequency. CONCLUSIONS Recognizing multimorbidity in patients with CM-MOH is important to enhance the management of these complex patients, who are at risk of polypharmacy and increased health care utilization.
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Affiliation(s)
- Domenico D'Amico
- Neuroalgology Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Emanuela Sansone
- Neuroalgology Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Licia Grazzi
- Neuroalgology Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Ambra M. Giovannetti
- Unit of Neuroepidemiology; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Silvia Schiavolin
- Neurology, Public Health and Disability Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
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6
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Grazzi L, Raggi A, D’Amico D, Sansone E, Leonardi M, Andrasik F, Gucciardi A, Guido D, D’Andrea G. A prospective pilot study of the effect on catecholamines of mindfulness training vs pharmacological prophylaxis in patients with chronic migraine and medication overuse headache. Cephalalgia 2018; 39:655-664. [DOI: 10.1177/0333102418801584] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Aim To address whether, in patients with chronic migraine and medication overuse headache, mindfulness-based treatment is associated with changes in plasma levels of catecholamines and elusive amines that are similar to those observed in patients undergoing pharmacological prophylaxis. Methods In this non-randomized, clinic-based effectiveness study, patients aged 18–65, with a history of chronic migraine ≥ 10 years and overuse of triptans or non-steroidal anti-inflammatory drugs ≥ 5 years, were enrolled. Upon completion of a structured withdrawal program, patients received either pharmacological prophylaxis or six weekly sessions of mindfulness-based treatment and were followed for 12 months. Daily headache diaries were used to record headache frequency and medication intake; catecholamines (noradrenaline, epinephrine and dopamine) and levels of elusive amines were assayed from poor platelet plasma. Results Complete follow-up data were available for 15 patients in the pharmacological prophylaxis-group (14 females, average age 44.1) and 14 in the mindfulness treatment-group (all females, average age 46.4), and all variables were comparable between groups at baseline. At 12 months, significant improvement ( p < .001) was found in the pharmacological prophylaxis group for headache frequency and medication intake (by 51% and 48.7%, respectively), noradrenaline, epinephrine and dopamine (by 98.7%, 120.8% and 501.9%, respectively); patients in the mindfulness treatment-group performed similarly. For elusive amines, no longitudinal changes were found. Conclusions The similar improvement trends observed in the two groups of patients further support the utility of mindfulness-based treatment in migraine care, and reinforce the hypothesis that alteration and normalization of tyrosine metabolism are implicated in migraine chronification and in remission of chronic migraine.
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Affiliation(s)
- Licia Grazzi
- Division of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Domenico D’Amico
- Division of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Emanuela Sansone
- Division of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Frank Andrasik
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | | | - Davide Guido
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Scaratti C, Covelli V, Guastafierro E, Leonardi M, Grazzi L, Rizzoli PB, D’Amico D, Raggi A. A Qualitative Study On Patients With Chronic Migraine With Medication Overuse Headache: Comparing Frequent And Non-Frequent Relapsers. Headache 2018; 58:1373-1388. [DOI: 10.1111/head.13385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2018] [Indexed: 12/28/2022]
Affiliation(s)
- Chiara Scaratti
- Public Health and Disability Unit, Neurological Institute “C. Besta” IRCCS Foundation; Neurology Milan Italy
| | | | - Erika Guastafierro
- Public Health and Disability Unit, Neurological Institute “C. Besta” IRCCS Foundation; Neurology Milan Italy
| | - Matilde Leonardi
- Public Health and Disability Unit, Neurological Institute “C. Besta” IRCCS Foundation; Neurology Milan Italy
| | - Licia Grazzi
- Headache and Neuroalgology Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Paul B. Rizzoli
- John R. Graham Headache Center, Department of Neurology; Brigham and Women's Faulkner Hospital; Boston MA USA
| | - Domenico D’Amico
- Headache and Neuroalgology Unit; Neurological Institute “C. Besta” IRCCS Foundation; Milan Italy
| | - Alberto Raggi
- Public Health and Disability Unit, Neurological Institute “C. Besta” IRCCS Foundation; Neurology Milan Italy
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8
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Bottiroli S, Allena M, Sances G, De Icco R, Avenali M, Fadic R, Katsarava Z, Lainez MJA, Goicochea MT, Bendtsen L, Jensen RH, Nappi G, Tassorelli C. Psychological, clinical, and therapeutic predictors of the outcome of detoxification in a large clinical population of medication-overuse headache: A six-month follow-up of the COMOESTAS Project. Cephalalgia 2018; 39:135-147. [DOI: 10.1177/0333102418783317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Aim To identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache. Methods Consecutive patients entering a detoxification program in six centres in Europe and Latin America were evaluated and followed up for 6 months. We evaluated anxious and depressive symptomatology (though patients with severe psychiatric comorbidity were excluded), quality of life, headache-related disability, headache characteristics, and prophylaxis upon discharge. Results Of the 492 patients who completed the six-month follow up, 407 ceased overuse following the detoxification (non overusers), another 23 ceased overuse following detoxification but relapsed during the follow-up. In the 407 non-overusers, headache acquired an episodic pattern in 287 subjects (responders). At the multivariate analyses, lower depression scores (odds ratio = 0.891; p = 0.001) predicted ceasing overuse. The primary headache diagnosis – migraine with respect to tension-type headache (odds ratio = 0.224; p = 0.001) or migraine plus tension-type headache (odds ratio = 0.467; p = 0.002) – and the preventive treatment with flunarizine (compared to no such treatment) (odds ratio = 0.891; p = 0.001) predicted being a responder. A longer duration of chronic headache (odds ratio = 1.053; p = 0.032) predicted relapse into overuse. Quality of life and disability were not associated with any of the outcomes. Conclusions Though exploratory in nature, these findings point to specific factors that are associated with a positive outcome of medication-overuse headache management, while identifying others that may be associated with a negative outcome. Evaluation of the presence/absence of these factors may help to optimize the management of this challenging groups of chronic headache sufferers.
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Affiliation(s)
- Sara Bottiroli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Marta Allena
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Grazia Sances
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberto De Icco
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Micol Avenali
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
| | - Ricardo Fadic
- Department of Neurology, Pontificia Catolica University of Chile, Santiago, Chile
| | | | - Miguel JA Lainez
- Foundation of the Valencian Community, University Clinical Hospital, Spain
| | - Maria Teresa Goicochea
- Integral Pain Centre, Fundación para la Lucha contra las Enfermedades Neurológicas Infantiles (FLENI), Buenos Aires, Argentina
| | - Lars Bendtsen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, Glostrup, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Centre, Department of Neurology, Glostrup Hospital, Glostrup, Denmark
| | - Giuseppe Nappi
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
| | - Cristina Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Italy
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Grazzi L, D’Amico D, Raggi A, Leonardi M, Ciusani E, Corsini E, D’Andrea G, Bolner A, Salgado-García F, Andrasik F, Sansone E. Mindfulness and pharmacological prophylaxis have comparable effect on biomarkers of inflammation and clinical indexes in chronic migraine with medication overuse: results at 12 months after withdrawal. Neurol Sci 2017; 38:173-175. [DOI: 10.1007/s10072-017-2874-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Grazzi L, Sansone E, Raggi A, D'Amico D, De Giorgio A, Leonardi M, De Torres L, Salgado-García F, Andrasik F. Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up. J Headache Pain 2017; 18:15. [PMID: 28161874 PMCID: PMC5292107 DOI: 10.1186/s10194-017-0728-z] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 01/27/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Chronic Migraine (CM) is a disabling condition, worsened when associated with Medication Overuse (MO). Mindfulness is an emerging technique, effective in different pain conditions, but it has yet to be explored for CM-MO. We report the results of a study assessing a one-year course of patients' status, with the hypothesis that the effectiveness of a mindfulness-based approach would be similar to that of conventional prophylactic treatments. METHODS Patients with CM-MO (code 1.3 and 8.2 of the International Classification of Headache Disorders-3Beta) completed a withdrawal program in a day hospital setting. After withdrawal, patients were either treated with Prophylactic Medications (Med-Group), or participated in a Mindfulness-based Training (MT-Group). MT consisted of 6 weekly sessions of guided mindfulness, with patients invited to practice 7-10 min per day. Headache diaries, the headache impact test (HIT-6), the migraine disability assessment (MIDAS), state and trait anxiety (STAI Y1-Y2), and the Beck Depression Inventory (BDI) were administered before withdrawal and at each follow-up (3, 6, 12 after withdrawal) to patients from both groups. Outcome variables were analyzed in separate two-way mixed ANOVAs (Group: Mindfulness vs. Pharmacology x Time: Baseline, 3-, 6-, vs. 12-month follow-up). RESULTS A total of 44 patients participated in the study, with the average age being 44.5, average headache frequency/month was 20.5, and average monthly medication intake was 18.4 pills. Data revealed a similar improvement over time in both groups for Headache Frequency (approximately 6-8 days reduction), use of Medication (approximately 7 intakes reduction), MIDAS, HIT-6 (but only for the MED-Group), and BDI; no changes on state and trait anxiety were found. Both groups revealed significant and equivalent improvement with respect to what has become a classical endpoint in this area of research, i.e. 50% or more reduction of headaches compared to baseline, and the majority of patients in each condition no longer satisfied current criteria for CM. CONCLUSIONS Taken as a whole, our results suggest that the longitudinal course of patients in the MT-Group, that were not prescribed medical prophylaxis, was substantially similar to that of patients who were administered medical prophylaxis.
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Affiliation(s)
- Licia Grazzi
- Neurological Institute "C. Besta" IRCCS Foundation, Headache and Neuroalgology Unit, Via Celoria 11, 20133, Milan, Italy.
| | - Emanuela Sansone
- Neurological Institute "C. Besta" IRCCS Foundation, Neurology, Public Health and Disability Unit, Milan, Italy
| | - Alberto Raggi
- Neurological Institute "C. Besta" IRCCS Foundation, Neurology, Public Health and Disability Unit, Milan, Italy
| | - Domenico D'Amico
- Neurological Institute "C. Besta" IRCCS Foundation, Headache and Neuroalgology Unit, Via Celoria 11, 20133, Milan, Italy
| | | | - Matilde Leonardi
- Neurological Institute "C. Besta" IRCCS Foundation, Neurology, Public Health and Disability Unit, Milan, Italy
| | - Laura De Torres
- Neurological Institute "C. Besta" IRCCS Foundation, Neurology, Public Health and Disability Unit, Milan, Italy
| | | | - Frank Andrasik
- Department of Psychology, Univeristy of Memphis, Memphis, TN, USA
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11
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Zidverc-Trajkovic JJ, Pekmezovic T, Jovanovic Z, Pavlovic A, Mijajlovic M, Radojicic A, Sternic N. Long-term predictors of remission in patients treated for medication-overuse headache at a specialized headache center: A prospective cohort study. Cephalalgia 2016; 38:265-273. [PMID: 27940881 DOI: 10.1177/0333102416683918] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To evaluate long-term predictors of remission in patients with medication-overuse headache (MOH) by prospective cohort study. Background Knowledge regarding long-term predictors of MOH outcome is limited. Methods Two hundred and forty MOH patients recruited from 2000 to 2005 were included in a one-year follow-up study and then subsequently followed until 31 December 2013. The median follow-up was three years (interquartile range, three years). Predictive values of selected variables were assessed by the Cox proportional hazard regression model. Results At the end of follow-up, 102 (42.5%) patients were in remission. The most important predictors of remission were lower number of headache days per month before the one-year follow-up (HR-hazard ratio = 0.936, 95% confidence interval (CI) 0.884-0.990, p = 0.021) and efficient initial drug withdrawal (HR = 0.136, 95% CI 0.042-0.444, p = 0.001). Refractory MOH was observed in seven (2.9%) and MOH relapse in 131 patients (54.6%). Conclusions Outcome at the one-year follow-up is a reliable predictor of MOH long-term remission.
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Affiliation(s)
- Jasna J Zidverc-Trajkovic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Tatjana Pekmezovic
- 2 Faculty of Medicine, University of Belgrade, Serbia.,3 Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Serbia
| | - Zagorka Jovanovic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Pavlovic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Milija Mijajlovic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Aleksandra Radojicic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
| | - Nadezda Sternic
- 1 Headache Centre, Neurology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.,2 Faculty of Medicine, University of Belgrade, Serbia
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Andrasik F, Grazzi L, D'Amico D, Sansone E, Leonardi M, Raggi A, Salgado-García F. Mindfulness and headache: A "new" old treatment, with new findings. Cephalalgia 2016; 36:1192-1205. [PMID: 27694139 DOI: 10.1177/0333102416667023] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Mindfulness refers to a host of procedures that have been practiced for centuries, but only recently have begun to be applied to varied pain conditions, with the most recent being headache. Methods We reviewed research that incorporated components of mindfulness for treating pain, with a more in depth focus on headache disorders. We also examined literature that has closely studied potential physiological processes in the brain that might mediate the effects of mindfulness. We report as well preliminary findings of our ongoing trial comparing mindfulness alone to pharmacological treatment alone for treating chronic migraine accompanied by medication overuse. Results Although research remains in its infancy, the initial findings support the utility of varied mindfulness approaches for enhancing usual care for headache management. Our preliminary findings suggest mindfulness by itself may produce effects comparable to that of medication alone for patients with chronic migraine and medication overuse. Conclusions Much work remains to more fully document the role and long term value of mindfulness for specific headache types. Areas in need of further investigation are discussed.
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Affiliation(s)
- Frank Andrasik
- 1 Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Licia Grazzi
- 2 Headache and Neuroalgology Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
| | - Domenico D'Amico
- 2 Headache and Neuroalgology Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
| | - Emanuela Sansone
- 3 Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
| | - Matilde Leonardi
- 3 Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
| | - Alberto Raggi
- 3 Neurology, Public Health and Disability Unit, Neurological Institute C. Besta IRCCS Foundation, Milan, Italy
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Relja G, Granato A, Bratina A, Antonello RM, Zorzon M. Outcome of Medication Overuse Headache after Abrupt in-Patient withdrawal. Cephalalgia 2016; 26:589-95. [PMID: 16674768 DOI: 10.1111/j.1468-2982.2006.01073.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
One hundred and one patients suffering from chronic daily headache (CDH) and medication overuse were treated, in an in-patient setting, with abrupt discontinuation of the medication overused, intravenous hydrating, and intravenous administration of benzodiazepines and ademetionine. The mean time to CDH resolution was 8.8 days. The in-patient withdrawal protocol used was effective, safe and well tolerated. There was a trend for a shorter time to CDH resolution in patients who overused triptans ( P = 0.062). There was no correlation between time to CDH resolution and either the type of initial primary headache or duration of medication abuse, whereas time to CDH resolution was related to daily drug intake ( P = 0.01). In multiple regression analysis, daily drug intake, age and type of medication overused were independent predictors of time to CDH resolution. At 3-months' follow-up, no patient had relapsed and was again overusing symptomatic medications.
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Affiliation(s)
- G Relja
- Department of Clinical Medicine and Neurology, Headache Centre, University of Trieste, Trieste, Italy
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Coeytaux RR, Spierings ELH. Prognostic Factors, Disability, and Functional Status among Patients in a Headache Specialty Practice. Cephalalgia 2016; 26:7-13. [PMID: 16396661 DOI: 10.1111/j.1468-2982.2005.00976.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study was to identify prognostic factors and assess functional status over time among patients in a headache specialty practice. Study questionnaires were mailed to 599 patients who previously presented to a headache specialty practice. Outcome measures included headache frequency, the Headache Impact Test (HIT) and the SF-36 Health Survey. Completed surveys were received from 333 respondents (56%). Thirty-five respondents (11%) had HIT scores in the ‘little or no impact’ range at follow-up and 191 (57%) had HIT scores in the ‘severe impact’ range. A diagnosis of migraine at baseline was an independent predictor of elevated HIT scores at follow-up, but gender, age, age at headache onset, daily headache at baseline, and time to follow-up did not predict poor prognosis. A subset of headache patients continue to experience marked disability and impaired functional status, months to years after presenting for headache specialty care. A diagnosis of migraine at the time of presentation may predict prognosis, but additional cohort studies with careful attention to baseline variables are needed to help identify other prognostic factors.
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Affiliation(s)
- R R Coeytaux
- University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA
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Giamberardino MA, Mitsikostas DD, Martelletti P. Update on Medication-Overuse Headache and Its Treatment. Curr Treat Options Neurol 2015; 17:368. [PMID: 26139553 DOI: 10.1007/s11940-015-0368-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OPINION STATEMENT Medication-overuse headache-i.e., a too-frequent consumption of acute headache medications leading to increased headache frequency and reduced effectiveness of acute and preventive treatments-is a serious medical condition whose pathophysiology still remains incompletely known, which is reflected into a lack of mechanism-based treatments. The first mandatory step in the therapeutic strategy remains withdrawal of the abused drug, preferably abrupt, in concomitance with a detoxification pharmacological regimen to lessen withdrawal symptoms. Intravenous hydration, antiemetics, corticosteroids (prednisone), tranquilizers (benzodiazepine), neuroleptics, and rescue medication (another analgesic than the overused) should be delivered in various combinations, on an inpatient (hospitalization and day hospital) basis or outpatient basis, depending on the characteristics of the specific patient and type of overuse. Inpatient withdrawal should be preferred in barbiturate and opioid overuse, in concomitant depression, or, in general, in patients who have difficulty in stopping the overused medication as outpatients. In contrast, in overuse limited to simple analgesics in highly motivated patients, without high levels of depression and/or anxiety, home detoxification should be chosen. Re-prophylaxis should immediately follow detoxification, ideally with local injections of onabotulinumtoxinA every 3 months or topiramate orally for at least 3 months. Adequate information to patients about the risks of a too-frequent consumption of symptomatic headache medications is essential and should constantly parallel treatment to help preventing relapse after detoxification and re-prophylaxis.
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Affiliation(s)
- Maria Adele Giamberardino
- Headache Center and Geriatrics Clinic, Department of Medicine and Science of Aging, "G. D'Annunzio" University, via Carlo de Tocco n. 3, 66100, Chieti, Italy,
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Chiang CC, Schwedt TJ, Wang SJ, Dodick DW. Treatment of medication-overuse headache: A systematic review. Cephalalgia 2015; 36:371-86. [PMID: 26122645 DOI: 10.1177/0333102415593088] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 06/03/2015] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The objective of this review is to provide an evidence-based discussion of different treatment strategies for medication-overuse headache (MOH). METHOD We searched PubMed for articles discussing the treatment and prognosis of MOH published between 2004 and August 2014. Titles, abstract and articles were reviewed systematically. The level of evidence provided by each study of the included articles was determined according to the American Academy of Neurology Clinical practice guideline manual. We discuss the level of evidence to support the early discontinuation/withdrawal of overused medications, the level of evidence to support the use of preventive treatment, the short- and long-term prognosis, and the outcome according to the class of drug overused in patients diagnosed with MOH. RESULTS The initial search resulted in 1313 articles; 68 articles met our inclusion criteria and were discussed. The level of evidence to support early discontinuation of overused medications alone is low due to the absence of controlled studies. Adding preventive medication to early discontinuation led to a better outcome than early discontinuation alone. For patients with chronic migraine (CM) and medication overuse (MO), there are large randomized control trials supporting the use of onabotulinumtoxinA and topiramate without early discontinuation of overuse; however, the evidence is limited since data were obtained from post hoc analysis. CONCLUSION Considering current available evidence and the systemic toxicity of overusing acute headache medication, we suggest discontinuation of the overused medication with the addition of preventive medication. Appropriately sized, randomized controlled trials evaluating the safety and long-term efficacy of preventive medication plus early discontinuation of overuse vs preventive medication alone vs early discontinuation of overuse alone are needed.
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Affiliation(s)
| | | | - Shuu-Jiun Wang
- Department of Neurology, Taipei Veterans General Hospital, Taiwan
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17
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Buse DC, Serrano D, Reed ML, Kori SH, Cunanan CM, Adams AM, Lipton RB. Adding Additional Acute Medications to a Triptan Regimen for Migraine and Observed Changes in Headache-Related Disability: Results From the American Migraine Prevalence and Prevention (AMPP) Study. Headache 2015; 55:825-39. [PMID: 25881857 DOI: 10.1111/head.12556] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Though triptans are the most widely used acute treatments for migraine, response to treatment is sometimes suboptimal. Triptan therapy is often augmented by the addition of other acute treatments. The benefits of this practice have not been examined in large-scale, real-world observational studies. OBJECTIVES To assess changes in headache-related disability associated with adding additional acute treatments to a triptan regimen by category of added treatment including: a second triptan, nonsteroidal anti-inflammatory drugs (NSAID), opioids or barbiturates. METHODS Subjects were participants in the American Migraine Prevalence and Prevention study, a longitudinal, US population-based study of individuals with "severe" headache. Respondents who met International Classification of Headache Disorders 3 beta criteria for migraine were on triptan therapy per respondent self-report, used the same triptan, and provided headache-related disability data for at least 2 consecutive years. Subjects were divided based on headache days per month into 3 groups: low-frequency episodic migraine (LFEM, 0-4), moderate-frequency episodic migraine (MFEM, 5-9), and high-frequency episodic migraine/chronic migraine (HFEM/CM, ≥ 10 headache days per month). HFEM and CM were combined into a single group for analyses because of sample size limitations. Patterns of acute treatment for migraine were monitored from one year to the next over the following couplets of years (2005-2006, 2006-2007, 2007-2008, and 2008-2009). The first eligible couplet was analyzed for each respondent. Medication regimens studied included: (1) maintaining current triptan use (consistent group); (2) adding a different triptan; (3) adding an NSAID; or (4) adding a combination analgesic containing opioids or barbiturates. We assessed change in Migraine Disability Assessment (MIDAS) score from the first to the second year of a couplet, contrasting scores of participants with consistent use with those who added an acute treatment to their triptan regimen. RESULTS The study sample (N = 2128) included 111 individuals who added another triptan, 118 who added an opioid or barbiturate, and 69 who added an NSAID, with referent groups of approximately 600 cases in each group who remained consistent. In general, MIDAS scores were higher among those who made changes from one year to the next compared with those who did not make changes in therapy. In fully adjusted models, adding triptans or NSAIDs was associated with increased disability for HFEM/CM cases at follow-up but decreased disability at follow-up for MFEM cases, resulting in significant interaction effects for both adding triptans and NSAIDs, respectively (15.88, 95% confidence interval [CI] 0.75, 31.01, 38.52, 95% CI 12.43, 64.61). CONCLUSIONS While the effects of adding vs staying consistent on the outcome of headache-related disability varied by medication type added and headache frequency strata, in general, these results suggest that for individuals with migraine, adding acute therapies to current triptan use is generally not associated with reductions in headache-related disability. The results were strongest among persons with HFEM and CM. These results identify important unmet medical needs in current migraine management, especially among patients with high-frequency migraine, and suggest that alternative treatment strategies are needed to improve patient outcomes.
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Affiliation(s)
- Dawn C Buse
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Headache Center, Bronx, NY, USA
| | - Daniel Serrano
- Albert Einstein College of Medicine, Bronx, NY, USA.,Endpoint Outcomes, Boston, MA, USA
| | | | - Shashi H Kori
- Formerly of Allergan Inc., Irvine, CA, USA.,Autonomic Technologies Inc., Redwood City, CA, USA
| | | | | | - Richard B Lipton
- Albert Einstein College of Medicine, Bronx, NY, USA.,Montefiore Headache Center, Bronx, NY, USA
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Sodium valproate in migraine without aura and medication overuse headache: a randomized controlled trial. Eur Neuropsychopharmacol 2014; 24:1289-97. [PMID: 24862255 DOI: 10.1016/j.euroneuro.2014.03.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 03/20/2014] [Accepted: 03/27/2014] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the efficacy, safety and tolerability of sodium valproate (800mg/die) compared with placebo in medication-overuse headache patients with a history of migraine without aura. METHODS This is a multicenter, randomized, double-blind, placebo-controlled study enrolled medication-overuse headache patients for a 3-month treatment period with sodium valproate (800mg/day) or placebo after a 6 day outpatient detoxification regimen, followed by a 3-month follow-up. Primary outcome was defined by the proportion of patients achieving ≥50% reduction in the number of days with headache per month (responders) from the baseline to the last 4 weeks of the 3-month treatment. Multivariate logistic regression models were used on the primary endpoint, adjusting for age, sex, disease duration, comorbidity and surgery. The last-observation-carried-forward method was used to adjust for missing values. RESULTS Nine sites enrolled 130 patients and, after a 6-day detoxification phase, randomized 88 eligible patients. The 3-month responder rate was higher in the sodium valproate (45.0%) than in the placebo arm (23.8%) with an absolute difference of about 20% (p=0.0431). Sodium valproate had safety and tolerability profiles comparable to placebo. CONCLUSIONS The present study supports the efficacy and safety of sodium valproate in the treatment of medication overuse headache with history of migraine after detoxification.
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Abstract
Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1%–2%. It is a severe form of headache where the patients often have a long history of headache and of unsuccessful treatments. MOH is characterized by chronic headache and overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This review focuses on aspects of epidemiology, diagnosis, pathogenesis, prevention, and treatment of MOH. We suggest that information and education about the risk of MOH is important since the condition is preventable. Most patients experience reduction of headache days and intensity after successful treatment. The first step in the treatment of MOH should be carried out in primary care and focus primarily on withdrawal, leaving prophylactic medication to those who do not manage primary detoxification. For most patients, a general practitioner can perform the follow-up after detoxification. More complicated cases should be referred to neurologists and headache clinics. Patients suffering with MOH have much to gain by an earlier treatment-focused approach, since the condition is both preventable and treatable.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Research Centre, Akershus University Hospital, Lørenskog, Norway ; Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway ; Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Christofer Lundqvist
- Research Centre, Akershus University Hospital, Lørenskog, Norway ; Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway ; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway
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Kristoffersen ES, Lundqvist C. Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Drug Saf 2014; 5:87-99. [PMID: 25083264 PMCID: PMC4110872 DOI: 10.1177/2042098614522683] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Medication-overuse headache (MOH) is one of the most common chronic headache disorders and a public health problem with a worldwide prevalence of 1-2%. It is a condition characterized by chronic headache and overuse of different headache medications, and withdrawal of the overused medication is recognised as the treatment of choice. However, the strategy for achieving withdrawal is, at present, based on expert opinion rather than scientific evidence, partly due to the lack of randomised controlled studies. This narrative review investigates different aspects of epidemiology, diagnosis, risk factors and pathogenesis as well as management for MOH. We suggest that the first step in the treatment of MOH should be carried out in general practice and should focus primarily on detoxification. For most patients, both prevention and follow up after detoxification can also be performed in general practice, thus freeing resources for referral of more complicated cases to headache clinics and neurologists. These suffering patients have much to gain by an earlier treatment-focused approach lower down on the treatment ladder.
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Affiliation(s)
- Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, and Research Centre, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Research Centre, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway, and Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway
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21
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Krymchantowski AV, Jevoux CDC. Chronic (transformed) migraine and medication overuse: to withdraw or not? Expert Rev Neurother 2014; 7:1065-7. [PMID: 17868003 DOI: 10.1586/14737175.7.9.1065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Serrano D, Buse DC, Kori SH, Papapetropoulos S, Cunanan CM, Manack AN, Reed ML, Lipton RB. Effects of switching acute treatment on disability in migraine patients using triptans. Headache 2013; 53:1415-29. [PMID: 23808937 DOI: 10.1111/head.12164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the influence of switching acute treatment on headache-related disability in a population sample of individuals with migraine using acute triptan therapy. BACKGROUND Acute treatments for migraine are often modified in clinical practice. The effect of changes in treatment from one triptan to another or from a triptan to another medication class has rarely been studied. METHODS Patterns of acute treatment for migraine were monitored from 1 year to the next in the American Migraine Prevalence and Prevention (AMPP) Study for the following couplets (2005-2006, 2006-2007, 2007-2008, and 2008-2009). Changes in medication regimens were classified as follows: (1) switch within the triptan class; (2) switch to combination analgesics containing opioids or barbiturates; (3) switch to non-steroidal anti-inflammatory drug (NSAID) agents; (4) maintaining current therapy (consistent use, "control"). We assessed change in migraine disability assessment scale score from the first to the second year of a couplet contrasting those with consistent use with those who changed acute treatment. Each individual contributed only 1 couplet to the analysis. Persons who added an acute treatment are considered in a separate manuscript. We modeled change in migraine disability assessment scale score as a function of change in medication regimen with consistent users as the control group. RESULTS We identified 81 individuals who switched to another triptan, with a referent of 619 who remained consistent, 31 cases who switched to an opioid or barbiturate with a referent of 666 who remained consistent, and 20 cases who switched to an NSAID with a referent of 667 cases who remained consistent. In cell-mean coded analyses of covariance (ANCOVA), switching from one triptan to another or switching from a triptan to an opioid/barbiturate was never associated with significant improvements in headache-related disability compared with consistent treatment. Switching from a triptan to an NSAID was associated with significant increases in headache-related disability among those with high-frequency episodic/chronic migraine (HFEM/CM) compared with those with low-frequency episodic migraine (LFEM) (interaction = 34.81, 95% confidence interval 10.61 to 59.00). The same was true comparing high-frequency episodic/chronic migraine with those with moderate-frequency episodic migraine (interaction = 48.73, 95% confidence interval 2.63 to 94.83). CONCLUSIONS In this observational study, switching triptan regimens does not appear to be associated with improvements in headache-related disability and in some cases is associated with increased headache-related disability.
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Day-hospital withdrawal for chronic migraine with medication overuse: results at 3 years follow-up. Neurol Sci 2013; 34 Suppl 1:S167-9. [DOI: 10.1007/s10072-013-1389-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grande RB, Aaseth K, Benth JŠ, Lundqvist C, Russell MB. Reduction in medication-overuse headache after short information. The Akershus study of chronic headache. Eur J Neurol 2011; 18:129-37. [PMID: 20528911 DOI: 10.1111/j.1468-1331.2010.03094.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE our aim was to investigate the course of medication-overuse headache in the general population and the effect of simple advice regarding medication overuse. DESIGN prospective cohort study. Participants were identified in a cross-sectional epidemiological sample of 30000 persons aged 30-44 from the general Norwegian population. People with chronic headache (≥ 15 days per month for at least 3 months) and medication overuse received short information about the possible role of medication overuse in headache chronification. A cohort was followed up 1½ years later. The diagnostic criteria of the International Classification of Headache Disorders and data splitting methodology were used. SETTING Akershus University Hospital, Oslo, Norway. PARTICIPANTS a total of 109 participants with chronic primary headache and medication overuse were available for follow-up (85% participation rate). MAIN OUTCOME MEASURE Change in medication days and headache days per month. RESULTS at baseline chronic tension-type headache was found in 92% of participants; 8% had chronic migraine or new daily persistent headache. Migraine co-occurrence was found in 53%. The mean duration of chronic headaches were 8-18 years, the mean duration of medication overuse between 5 and 10 years prior to intervention. At follow up, the mean medication days were significantly reduced from 22 days to 6 days per month, and 76% no longer had medication overuse. Forty-two percent no longer had chronic headache and the headache index was reduced by 24%. CONCLUSION our examination and short information served as a modified brief intervention which can improve chronic headache and medication overuse in the general population.
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Affiliation(s)
- R B Grande
- Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog Faculty Division Akershus University Hospital, University of Oslo, Norway
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Disability in chronic daily headache: state of the art and future directions. Neurol Sci 2011; 32 Suppl 1:S71-6. [DOI: 10.1007/s10072-011-0552-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Lantéri-Minet M, Duru G, Mudge M, Cottrell S. Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: a systematic review. Cephalalgia 2011; 31:837-50. [PMID: 21464078 DOI: 10.1177/0333102411398400] [Citation(s) in RCA: 197] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the evidence for quality of life (QoL) impairment, disability, healthcare resource use and economic burden associated with chronic daily headache (CDH), focusing on chronic migraine (CM) with or without medication overuse. METHODS A systematic review and qualitative synthesis of studies of patients/subjects with CDH that included CM, occurring on at least 15 days per month. MAIN FINDINGS Thirty-four studies were included for review (25 studies of patients and nine of subjects from the general population). CDH and CDH with medication overuse headache (MOH) were consistently associated with a lower QoL compared to control or episodic headache (EH) and CDH without MOH. CDH was consistently associated with greater disability and productivity loss, more consultations, more or longer hospitalizations and higher direct costs than EH. Data were not amenable to statistical pooling. PRINCIPAL CONCLUSIONS The findings of this review underline the detriment to QoL and the disabling nature of CDH, and in particular CM and CDH with MOH, and negative impact on workplace productivity compared to other types of headache.
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Affiliation(s)
- Michel Lantéri-Minet
- Département d’Evaluation et Traitement de la Douleur Médecine Palliative, Pôle Neurosciences Cliniques, CHU de Nice-Hôpital Pasteur, 30 Avenue de la Voie Romaine, Nice cedex 1, France.
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Andrasik F, Grazzi L, Usai S, Kass S, Bussone G. Disability in chronic migraine with medication overuse: treatment effects through 5 years. Cephalalgia 2010; 30:610-4. [PMID: 19614686 DOI: 10.1111/j.1468-2982.2009.01932.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronic migraine accompanied by medication overuse is particularly difficult to treat. The number of treatment investigations is limited, few have included follow-up beyond 6 months and almost none has examined whether treatment leads to concurrent improvements in disability and functional impairment. This open-label study addresses these limitations. We have been prospectively following an initial cohort of 84 chronic migraine patients with medication overuse, who at the time of this evaluation had been reduced to 58, for an extended period to assess longer-term maintenance of effects, using measurement procedures identical to those in the original investigation. Thus, the specific aim was to determine the clinical status, with respect to pain indices and disability level, of chronic migraine patients with medication overuse who were treated and followed prospectively for 5 years. All patients completed a brief inpatient treatment programme, in which they were withdrawn from their offending medications and subsequently placed on more appropriate preventive antimigraine medications. Both end-point, wherein missing data points were estimated, and continuer analyses, wherein data analysis was limited to the 58 individuals with complete datasets, revealed significant improvement on all measures studied-headache days per month, analgesic consumption and Migraine Disability Assessment (MIDAS) total score. The percentage reduction from baseline to 5 years for the MIDAS total score was 76.0%, while the percentage of individuals revealing improvements of clinically significant magnitude (≥ 50%) on the MIDAS was 91.9%. MIDAS total scores were lower at 5 years than at some of the intervening follow-up intervals. Comparisons of those who completed the 5-year follow-up (n = 58) with those who did not revealed no differences at baseline. This finding, coupled with the nearly identical results for the end-point and continuers analyses, suggests that attrition did not have a bearing on outcome. None of the patients completing the 5-year follow-up had relapsed since the prior 3-year follow-up assessment. High levels of maintenance were revealed at 5 years, with disability scores showing some continued improvement over time. The implications of these findings and the limitations of the study are discussed.
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Affiliation(s)
- F Andrasik
- Department of Psychology, University of West Florida, Pensacola, FL 32514, USA.
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Bøe MG, Salvesen R, Mygland Å. Chronic daily headache with medication overuse: predictors of outcome 1 year after withdrawal therapy. Eur J Neurol 2009; 16:705-12. [DOI: 10.1111/j.1468-1331.2009.02571.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grazzi L, Andrasik F, Usai S, Bussone G. Treatment of chronic migraine with medication overuse: is drug withdrawal crucial? Neurol Sci 2009; 30 Suppl 1:S85-8. [DOI: 10.1007/s10072-009-0079-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dodick DW, Silberstein SD. How Clinicians can Detect, Prevent and Treat Medication Overuse Headache. Cephalalgia 2008; 28:1207-17. [DOI: 10.1111/j.1468-2982.2008.01737.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- DW Dodick
- Mayo Clinic College of Medicine, Department of Neurology, Scottsdale, AZ
| | - SD Silberstein
- Thomas Jefferson University, Department of Neurology, Philadelphia, PA, USA
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Calhoun A, Ford S. Elimination of Menstrual-Related Migraine Beneficially Impacts Chronification and Medication Overuse. Headache 2008; 48:1186-93. [DOI: 10.1111/j.1526-4610.2008.01176.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grazzi L, Andrasik F, Usai S, Bussone G. In-patient vs. day-hospital withdrawal treatment for chronic migraine with medication overuse and disability assessment: results at one-year follow-up. Neurol Sci 2008; 29 Suppl 1:S161-3. [DOI: 10.1007/s10072-008-0913-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Headache with medication overuse: treatment strategies and proposals of relapse prevention. Neurol Sci 2008; 29:93-8. [DOI: 10.1007/s10072-008-0867-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Accepted: 03/10/2008] [Indexed: 10/22/2022]
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Andrasik F, Grazzi L, Usai S, D'Amico D, Kass S, Bussone G. Disability in chronic migraine with medication overuse: treatment effects at 3 years. Headache 2007; 47:1277-81. [PMID: 17927643 DOI: 10.1111/j.1526-4610.2007.00861.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the clinical status, with respect to pain indices and disability level, of chronic migraine patients with medication overuse who were treated 3 years previously. BACKGROUND Patients who have chronic migraine accompanied by medication overuse are particularly difficult to treat. Investigations are limited in number, few have included follow-up beyond 6 months, and almost none have examined whether treatment leads to concurrent improvements in disability and functional impairment. In a prior report, we described the clinical course of 84 such patients followed for 1 full year after treatment. METHODS These same 84 patients were followed for 2 additional years to assess longer term maintenance of effects, using measurement procedures identical to those in the original investigation. RESULTS Both endpoint and completer analyses revealed significant improvement on all measures studied-headache days per month, analgesic consumption, and MIDAS scores (Total, Headache Frequency, and Headache Intensity)-with some loss of benefits over time for the pain indices. MIDAS total scores, however, were lower at 36 months than at 6 months. Comparisons of those who completed the 3-year follow-up to those who did not revealed few differences at baseline. All of this suggests attrition did not have a bearing on outcome. DISCUSSION High levels of maintenance were revealed at 3 years. Even though reports of pain revealed some lessening of effects, this was not accompanied by reports of deterioration in functioning. This suggests that patients have learned to adapt and adjust to headaches in their daily lives.
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Affiliation(s)
- Frank Andrasik
- Department of Psychology, University of West Florida, Pensacola, FL 32514, USA
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Coskun O, Ucler S, Cavdar L, Inan LE. Effect of valproic acid on withdrawal therapy in patients with overuse of chronic daily headache medications. J Clin Neurosci 2007; 14:334-9. [PMID: 16647854 DOI: 10.1016/j.jocn.2006.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Revised: 12/29/2005] [Accepted: 01/09/2006] [Indexed: 11/29/2022]
Abstract
Discontinuation of medication is the treatment of choice for patients with chronic daily headache (CDH) who overuse their medications. This treatment may be difficult due to increased headache severity observed in patients immediately after withdrawal. We retrospectively evaluated the efficacy of valproic acid therapy in 66 patients with overuse of CDH medication during withdrawal therapy. Patients were all withdrawn from medications and valproic acid started at 250 mg or 500 mg daily. Forty-two (63.6%) patients had decreased headache severity, including 27.3% objective responses in the first week. At the last visit in the 12th week, 50 patients were headache-free and only one patient had persistent headache. Fifteen patients withdrew from therapy due to side effects and lost to follow-up within this timeframe. Thus, low dose valproic acid appears to be safe and effective in the management of withdrawal therapy.
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Affiliation(s)
- Ozlem Coskun
- Department of Neurology, Ministry of Health Ankara Research and Training Hospital, Ankara, Turkey.
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Grazzi L, Andrasik F. Medication-overuse headache: Description, treatment, and relapse prevention. Curr Pain Headache Rep 2006; 10:71-7. [PMID: 16499833 DOI: 10.1007/s11916-006-0012-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Medication-overuse headache (MOH) has increasingly become a focus within the field of headache. The biologic and physiopathologic origin for MOH likely resides in receptor physiology, but it also is probable that the initiation and sustaining dynamics of this pathologic condition involve several other factors. Not all patients with frequent headache eventually overuse their medications, but when it happens (the percentage is approximately 1%), the diagnosis of MOH is clinically important because patients rarely respond to preventive medications while overusing acute medications. Properly treating medication overuse and preventing relapse require recognition of the different factors that contribute to its development and perpetuation, including some behaviors and psychologic elements that are important in sustaining the overuse of medication. The problem regarding the diagnosis, the classification, and clinical aspects of MOH is reviewed in this article. The different therapeutic approaches, initial outcomes, and long-term durability of treatment also are discussed.
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Affiliation(s)
- Licia Grazzi
- Headache Center, Neurological Institute C.Besta, Milan, Italy.
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Andrasik F, Lipchik GL, McCrory DC, Wittrock DA. Outcome Measurement in Behavioral Headache Research: Headache Parameters and Psychosocial Outcomes. Headache 2005; 45:429-37. [PMID: 15953259 DOI: 10.1111/j.1526-4610.2005.05094.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The experience of pain is complex and includes multiple dimensions or aspects, such as sensory and affective (among others). Headache includes not only pain, but also associated symptoms that can further diversify the relevant dimensions. Subjective ratings of head pain, sampled daily, have come to be regarded as the "gold standard" in behavioral headache research. Primary measures of headache include the attack frequency or headache days per month. Secondary measures of headache may include headache activity/index, headache duration, peak headache severity, and/or frequency of severe headaches per month. Secondary measures of disability and quality of life include Migraine Disability Assessment (MIDAS), Headache Impact Test (HIT), Headache Disability Inventory (HDI). Secondary nonheadache measures include medication consumption, psychiatric symptoms, stress and coping, treatment satisfaction and preference, side effects, and others. Researchers should include not only primary measures of headache, but also secondary measures, disability and quality of life, and nonheadache measures. All measures should be clearly defined and reported. A baseline period that is adequate for each measure needs inclusion and a minimum of 4 weeks is recommended for primary headache measures. Specific suggestions for future research directions are provided.
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Affiliation(s)
- Frank Andrasik
- Institute for Human and Machine Cognition, University of West Florida, Pensacola 32502, USA
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