Objective.-To quantify and characterize the similarities and the differences between chronic migraine (CM) patients with medication overuse and episodic migraine (EM) patients with only occasional analgesic use. Background.-Population-level epidemiology, characteristics, mechanisms of chronic daily headache, and medication-overuse headache have been widely studied but patient characteristics have received less attention.Methods.-We compared sociodemographic data, family history, physiological and medical history, health services utilized, drugs taken/prescribed, and outcome of 2 groups of subjects: 150 patients, suffering from CM, complicated by probable medication-overuse headache (CM group), consecutively admitted during 2005 to the inpatients' ward of the Headache Centre of the University Hospital of Modena and Reggio Emilia, Italy, to undergo withdrawal from their overused medications; 100 patients suffering from EM, uncomplicated by medication overuse (EM group), consecutively referred to the outpatients' ward of the Headache Centre during November and December 2005.Results.-All sociodemographic characteristics were significantly different between the 2 groups. As a whole, the CM group began to suffer from migraine earlier than the EM group. Drug and/or alcohol abuse was significantly higher among first-degree relatives of CM (19%) than of EM (6%) patients. The most frequent comorbid disorders were psychiatric (67%) and gastrointestinal diseases (43%) in the CM group, and allergies in the EM group (31%). Seventy percent of CM patients and 42% of EM patients were taking daily at least another drug, besides those for headache treatment. Most overused medications in the CM group were triptans (43%); the EM group used above all single NSAIDs (56%). At 3-month follow-up, prophylactic treatments reduced, by at least 50%, the frequency of headache in about three-fourths of patients of both the groups; however, headache remained significantly more frequent in the CM than in EM group: only a minority (15%) of CM patients reverted to a headache frequency comparable to that of the EM group.Conclusions.-CM patients present more multiple comorbid disorders, polypharmacy, and social impediments than EM patients. These associated conditions complicate CM clinical management. Even after withdrawal from medication overuse, CM could not be completely reverted by current prophylactic treatments.
Our aim was to compare the need for analgesics/drugs of abuse between headache patients--chronic and episodic headache sufferers--and addicts, by the Leeds Dependence Questionnaire (LDQ). This is a self-completion 10-item instrument to measure dependence upon a variety of substances. We administered the LDQ questionnaire to 122 chronic daily headache (CDH) sufferers who had been taking one dose of analgesic drug every day for at least 1 year; 71 subjects suffering from episodic headache (EH) using analgesics only occasionally; 115 consecutive drug addicts (DA) with a diagnosis of substance dependence. The mean LDQ total score was similar in the CDH (11.58+/-6.35) and DA (10.37+/-6.51) groups, and for both it was significantly higher than the score in the EH (5.61+/-3.00) group (P<0.001). The CDH group had the highest scores, and higher scores than the DA group (Z=-8.18, P<0.001) in item 8, assessing the primacy of effect over the kind of analgesic used, and in item 10 (Z=-5.03, P<0.001), asking if it is difficult to live without the analgesic; the DA group had the highest scores, and higher scores than the CDH group, in item 9 (Z=-5.07, P<0.001) addressing the need for the continued administration of the drug to maintain well-being, and in item 3 (Z=-2.39, P<0.05), exploring compulsion to start the use of the drug. The EH group had lower scores in all items (P<0.05) except for item 9, where there was no difference from CDH group; the EH group had also lower scores (P<0.001) than the DA group, except for item 8, where, instead, the score was higher than in the DA group (Z=-5.33, P<0.001). A strong link develops between chronic headache patients and the analgesics they use. This sort of 'dependence' appears to be a consequence of headache, originating from the necessity for the analgesic to cope with everyday life.
We evaluated 102 patients attending the Headache Study Center of the University of Modena who were suffering from chronic daily headache with daily drug intake. Patients underwent either day hospital treatment followed by a standard prophylactic therapy or they started prophylactic therapy immediately. After 30 and 120 days, both the Headache index and the daily drug intake had significantly improved (P < 0.001), and there were no differences in reduction of mean values of the Headache index or daily drug intake with respect to the two treatments, nor with regard to the prophylactic therapy chosen. Twenty-eight percent of patients reverted to daily drug intake after a 4-month follow-up; these patients took barbiturate-containing mixtures in a higher percentage than other drugs, and within the group of relapsing patients the outpatients relapsed to analgesic intake more than the day hospital-treated patients (P < 0.05).
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