Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial

Abstract

BackgroundMedication-overuse headache (MOH) is common in the general population. We investigated effectiveness of brief intervention (BI) for achieving drug withdrawal in primary care patients with MOH.MethodsThe study was double-blind, pragmatic and cluster-randomised controlled. A total of 25 486 patients (age 18–50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and were randomised to receive BI training (23 GPs) or to continue business as usual (BAU; 27 GPs). The Severity of Dependence Scale was applied as a part of the BI. BI involved feedback about individual risk of MOH and how to reduce overuse. Primary outcome measures were reduction in medication and headache days/month 3 months after the intervention and were assessed by a blinded clinical investigator.Results42% responded to the postal screening questionnaire, and 2.4% screened positive for MOH. A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study. BI was significantly better than BAU for the primary outcomes (p<0.001). Headache and medication days were reduced by 7.3 and 7.9 (95% CI 3.2 to 11.3 and 3.2 to 12.5) days/month in the BI compared with the BAU group. Chronic headache resolved in 50% of the BI and 6% of the BAU group.ConclusionsThe BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH.Trial registration numberNCT01314768.

The heterogeneity of headache patients who self-medicate: a cluster analysis approach

“…Moreover, this simple advice has proven its effectiveness in both prevention and treatment of MOH in other settings, i.e. general practice [21] and hospital [13; 30]. In addition, pharmacists should be vigilant for risk factors for pain chronification and could proactively identify and address concerns about pain medication, which may help to enhance adherence and detect (fear of) addiction.…”

Predictors of successful primary care detoxification treatment for medication-overuse headache

“…6 We have previously shown that a brief intervention (BI) based on information and advice is effective treatment for MOH in a diverse primary care population. 7 There was no significant improvement in the BAU (mean reduction in headache and medication days by 0.7 (95% CI: −0.5 to 1.8) and 0.6 (95% CI: −0.1 to 1.2) days/month, respectively). Furthermore, chronic headache resolved in 50% of the BI.…”

“…1,2,4,5 The personal and social costs are substantial as MOH is among the leading world causes of disability. 7,8 After 3 months, headache and medication days were reduced by 7.3 (95% CI: 3.2-11.3) and 7.9 (95% CI: 3.2-12.5) more days/month in the BI group than in the business as usual (BAU) group. 7,8 After 3 months, headache and medication days were reduced by 7.3 (95% CI: 3.2-11.3) and 7.9 (95% CI: 3.2-12.5) more days/month in the BI group than in the business as usual (BAU) group.…”

“…7,8 After 3 months, headache and medication days were reduced by 7.3 (95% CI: 3.2-11.3) and 7.9 (95% CI: 3.2-12.5) more days/month in the BI group than in the business as usual (BAU) group. 7 However, it is unknown what predicts successful withdrawal and which patients that revert to an episodic headache pattern after such withdrawal. 7 There was no significant improvement in the BAU (mean reduction in headache and medication days by 0.7 (95% CI: −0.5 to 1.8) and 0.6 (95% CI: −0.1 to 1.2) days/month, respectively).…”

The Effectiveness of Treatments for Patients With Medication Overuse Headache: A Systematic Review and Meta-Analysis

“…Overall we found no statistical significant differences between the inpatient or outpatient treatment on number of responders We found a statistical significant reduction of 10.5 (95%CI: 2.6; 18.5; 2 trials, 148 participants, I 2 =0%) days with medication use in favor of the inpatient treatment. Furthermore we found no statistical significant difference between a brief intervention by the GP versus usual care [18], abrupt withdrawal versus preventive treatment [14], follow-up by the neurologist versus follow-up by the GP [3], in-or outpatient treatment versus no treatment [26], or between biofeedback assisted relaxation therapy versus no treatment [11].…”