Complete withdrawal is the most effective approach to reduce disability in patients with medication-overuse headache: A randomized controlled open-label trial.

BACKGROUND: Medication-overuse headache leads to high disability and decreased quality of life, and the best approach for withdrawal has been debated. AIM: To compare change in disability and quality of life between two withdrawal programs. METHODS: We randomized medication-overuse headache patients to program A (two months without acute analgesics or migraine medications) or program B (two months with acute medications restricted to two days/week) in a prospective, outpatient study. At 6 and 12 months, we measured disability and headache burden by the Headache Under-Response to Treatment index (HURT). We estimated quality of life by EUROHIS-QOL 8-item at 2-, 6-, and 12-month follow-up. Primary endpoint was disability change at 12 months. RESULTS: We included 72 medication-overuse headache patients with primary migraine and/or tension-type headache. Fifty nine completed withdrawal and 54 completed 12-month follow-up. At 12-month follow-up, 41 patients completed HURT and 38 completed EUROHIS-QOL 8-item. Disability reduction was 25% in program-A and 7% in program-B ( p = 0.027). Headache-burden reduction was 33% in program-A and 3% in program-B ( p = 0.005). Quality of life was increased by 8% in both programs without significant difference between the programs ( p = 0.30). At 2-month follow-up, quality of life increased significantly more in program-A than program-B ( p = 0.006). CONCLUSION: Both withdrawal programs reduced disability and increased quality of life. Withdrawal without acute medication was the most effective in reducing disability in medication-overuse headache patients. TRIAL REGISTRATION: Clinicaltrials.gov (NCT02903329).

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.

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.

Health and quality of life in patients with medication overuse headache syndrome after standardized inpatient rehabilitation: A cross-sectional pilot study.

The aim of this pilot study was to determine health-related quality of life (HRQoL) in patients with history of medication overuse headache (MOH) after detoxification and a headache-specific inpatient rehabilitation program and to receive necessary information for future prospective studies.HRQoL and headache-related disability were cross-sectionally measured by Short Form 36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Migraine Disability Score (MIDAS), Coping Strategies Questionnaire (CSQ), and Symptom Checklist 90 revised (SCL-90-R). SF-36, HADS, and SCL-90-R data were compared to German population norms, stratified by age, sex, and comorbidities.Fifty-one patients (72.5% females, mean age 47.3 years) were included with an average headache duration of 25.3 years. Moderate to high levels of headache were reported on the MIDAS VAS at 6.51 (range 0-10); SF-36 bodily pain was 40.3 (norm = 59.0, P < .001, 100 = best). Impaired functioning averaged at 78.4 (100 = no impairment) on the MIDAS. In contrast, SF-36 physical functioning was comparable to the norm (mean: 78.4, norm = 81.8, P = .63). All other SF-36 scales were significantly lower than expected from the norm (all P < .001). The scales depression, anxiety, obsessive-compulsive, and interpersonal sensitivity were significantly affected, whereas the levels of SCL-90-R schizophrenia nuclear and schizotypia were not lower than the norm. Coping with pain was moderate.This pilot study is the first that presents a comprehensive and simultaneously specific assessment of health and quality of life of MOH patients after detoxification and inpatient rehabilitation. Moderate to high levels of pain and self-reported disability owing to headache were observed, whereas physical function on the SF-36 was not different from the expected level of the norm. Mental health was substantially affected in several dimensions, which had been described to reduce the ability to cope with pain. MOH patients seem to have high expectations of functionality, low symptomatology, and intact well-being.

A randomized trial of telephone-based motivational interviewing for adolescent chronic headache with medication overuse.

INTRODUCTION: Nearly 2% of youths suffer from chronic migraine or chronic tension-type headache (CTTH). A contributing factor in approximately 20%-50% of these youths is medication overuse, which involves taking analgesics three or more times per week for three months. The objective of this study was to test motivational interviewing (MI) as an approach to promote adherence to recommendations regarding not only analgesic overuse but also other aspects of treatment plans. METHODS: A randomized controlled trial was conducted comparing the experimental condition (standard of care clinic-based treatment with supplemental MI phone calls; N = 24) to a control condition (standard of care clinic-based treatment without these supplemental MI phone calls; N = 23). Four months after enrollment, a research assistant who was blinded to study condition telephoned adolescents inquiring about headache frequency, headache severity, and disability. RESULTS: Headache frequency was lower in the experimental condition versus control condition for those with relatively lower initial levels of headache frequency. In contrast, we did not find greater improvement in headache severity and disability for the experimental condition relative to the control condition. DISCUSSION: Our findings provided some preliminary, albeit limited, support for MI as an approach to improve outcomes for adolescent medication-overuse headache (MOH).