Long-term predictors of remission in patients treated for medication-overuse headache at a specialized headache center: A prospective cohort study

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.

The Many Faces of Medication‐Overuse Headache in Clinical Practice

“…Relapse or continued overuse was present in between 20% and 50% of patients in most studies 173 . Evidence suggests that most relapses occur in the first year after withdrawal (over 90% of patients) 169,174 . MOH patients with migraine as the underlying primary headache disorder were found to have significantly lower rates of relapse after 1 year, compared to 4 years for patients with TTH as underlying headache disorder 175‐177 .…”

“…Other predictors for poor outcomes after withdrawal strategies may be certain headache characteristics (high frequency of headache days before withdrawal, length of overuse, greater number of previous treatments, number of overused drugs, return to the overused drug), socioeconomic factors (unemployment, unmarried, less frequent consumption of coffee, smoking, alcohol consumption), previous history of withdrawal, comorbidities (depression, tendency for substance dependency), and greater disability (high MIDAS scores, low self‐reported sleep quality, and low SF‐36 scores on bodily pain) 57,73,169,178‐184 . Positive factors that may predict long‐term remission are efficient withdrawal from the beginning, and low headache frequency within the first year after withdrawal 174,185 …”

Medication-overuse headache: a widely recognized entity amidst ongoing debate

“…Successful withdrawal has been found in around 50–70% of MOH patients after 1 year [ 68 , 162 – 170 ]. Retaining full withdrawal after 1 year was found to be a good predictor for long-term success [ 171 , 172 ]. In studies with long-term evaluations up to 6 years, relapsing rates between 40 and 50% were found [ 163 , 164 , 173 – 177 ].…”

Medication Overuse Headache

“…Successful withdrawal was found in around 50-70% of MOH patients after 1 year [105][106][107][108][109][110][111][112][113]. Managing to retain full withdrawal after 1 year was found to be a good predictor for long-term success [114,115].A successful withdrawal leads to a better response for prophylactic treatment, even in patients with little improvement in headache frequency [116].Tension-type headache have documented to have a higher relapse risk [105-107, 117, 118]. Patients who kept overusing medication in the long-term had a poor response to withdrawal therapy and had a higher frequency of chronic headache [114].…”