Analyzing the predictors of relapse in drug-induced headache: a prospective clinical and psychological study

Abstract

The prevalence of drug-induced headache (DIHA) in the population is about 7%, and the relapse rate of DIHA after successful treatment is about 40% within 5 years.Objective: to analyze the risk factors for recurrence of DIHA and to develop a prognostic model for the probability of relapse after treatment.Material and methods. The characteristics of 117 patients with DIHA were analyzed on the basis of clinical data and questionnaire data using headache scales (MMAS-8, MIDAS, HALT, HIT-6, mTOQ-5), psycho-emotional profiles (PCS, Spielberger-Hanin Anxiety Scale, PHQ-9, BIS-11, TAS-26, SAGE test, LDQ) that were performed at the time of admission to the clinic and 9 months after the start of therapy. All patients enrolled in the study received a complex treatment that included an educational conversation, “detoxification” and symptomatic therapy during the withdrawal period along with a preventive treatment for chronic migraine (CM).Results. It was shown that there is still a low level of diagnosing of CM and DIHA. By creating a prediction model for the likelihood of recurrence of DIHA, we were able to identify the most important factors for an unfavorable course and recurrence of excessive analgesics use: frequency of analgesic use per day (OR 15.8; 95% C113.1—23.4), degree of alexithymia (score on TAS-26 scale: OR 11.3; 95% CI 6.3—18.1), frequency of combined analgesic use per month (OR 7.1; 95% CI 4.3—11.7), degree of pain catastrophizing on the PCS scale (OR 4.7; 95% CI 1.2—7.3), duration of symptomatic drug abuse (OR 3.2; 95% CI2.1—5.7).Conclusion. A high level of concomitant psychoemotional disorders, especially alexithymia and impulsive behaviour, is a significant risk factor for relapse and should be considered in the treatment of comorbid pathologies. It can be assumed that monoclonal antibodies against calcitonin gene-related peptides, botulinum therapy or combined treatment may be the treatment of choice in cases of ineffective prevention and detoxification attempts in the past as well as in cases of prolonged analgesic abuse.