A 4-year follow-up of patients with medication-overuse headache previously included in a randomized multicentre study

Abstract

The aim of this study was to evaluate the long-term outcome in 61 patients with medication-overuse headache (MOH) who 4 years previously had been included in a randomized open-label prospective multicentre study. Sixty patients still alive after 4 years were invited to a follow-up investigation. Fifty patients (83%) participated. Sixteen visited a neurologist, 22 were interviewed through telephone, 2 gave response by a letter, and 10 were evaluated through hospital records. The influence of baseline characteristics on outcome 4 years later was evaluated by non-parametric tests. p values below 0.01 were considered significant. At follow-up, the 50 persons had a mean reduction of 6.5 headache days/month (p < 0.001) and 9.5 acute headache medication days/month (p < 0.001) compared to baseline. Headache index/month was reduced from 449 to 321 (p < 0.001). Sixteen persons (32%) were considered as responders due to a ≥50% reduction in headache frequency from baseline, whereas 17 (34%) persons met the criteria for MOH. None of the baseline characteristics consistently influenced all five outcome measures. Total Hospital Anxiety and Depression Scale (HADS) score at baseline was predictors (p < 0.005) for being a responder after 4 years. At 4 years’ follow-up, one-third of the 50 MOH patients had ≥50% reduction in headache frequency from baseline. A low total HADS score at baseline was associated with the most favorable outcome.

Psychiatric screening for migraine patients

“…Anxiety and mood symptoms have been considered capable of influencing the long-term outcome. In their 4-year follow-up study, Hagen and colleagues [21] reported that a low depression score at baseline was the only factor associated with a favorable outcome. As Table 2a shows, our sample was affected by severe chronic migraine and MO characterized by severe dependency-like behaviors, significant anxiety and depression levels.…”

“…Several studies suggest predictors of relapse after a successful detoxification in samples of chronic migraineurs with MO [1,12,[19][20][21][22]. However, in tertiary centers, these putative factors are present and severe to such an extent that they could reciprocally influence each other and blur the clinical presentation and the physician manageability.…”

A Short Review on Medication-Overuse Headache

“…It has to be considered that a higher baseline degree of burden, as with the daily headache sufferers, may result in better compliance with the treatment strategies than with those having headache attacks fewer days a week [14].…”

Update on Medication-Overuse Headache and Its Treatment

“…The short-term response (2-month follow-up) to drug withdrawal in MOH has been suggested to be genetically determined [40]. Regarding relapse, recent studies indicate that the highest risk is in the first 12 months, although different percentages are reported by various authors (22-44 % in Trucco et al [41]; 60-75 % in Zidverc et al [42] and Baumgartner et al [43]; or 40-60 % in Andrasik [15], Katsarava [44], Hagen et al [45], and Fritsche et al [46]). The risk decreases, however, if medication overuse is avoided for 12 months after withdrawal, and in general, MOH treatment is considered successful if the improvement obtained after withdrawal/detoxification with or without prophylaxis is maintained at 1-year follow-up [42,[47][48][49][50][51].…”