Dependency-like behaviors and pain coping styles in subjects with chronic migraine and medication overuse: results from a 1-year follow-up study

Abstract

BackgroundEven after successful detoxification, 20-40% of subjects presenting chronic migraine with symptomatic medication overuse (CMwMO) relapse into medication overuse within one year. In this restrospective analysis on subjects referred to our center for detoxification, we investigated whether personality traits, dependency-like behaviors and pain coping styles predicted those who relapsed into medication overuse within the 12 months following the detoxification and those who did not.Methods63 patients with CMwMO were assessed for personality traits, mood and anxiety, pain coping styles and dependency-like behaviors prior-to and one year after a detoxification program.ResultsOf the 42 subjects who attended 1-year follow-up interviews, 11 relapsed into medication overuse despite a temporary benefit from detoxification and did not show clinical or psychological improvement, instead reporting increased anxiety and unmodified perpetuation of severe dependency-like behaviors. In contrast, subjects who did not relapse into medication overuse had clinical improvements that generalized to untreated domains, including decreased depressive symptoms and dependency-like behaviors, although showing unmodified low internal control over pain.ConclusionsSubjects who did not fall into medication overuse throughout the 12 months following the detoxification showed improved clinical, affective and dependence-related outcomes, but not pain coping strategies. Conversely, subjects who relapsed within one year into CMwMO continued to experience significant disability, pain intensity, and dependency-like behaviors. We believe that the persistence of maladaptive pain coping strategies and residual symptomatology increase the risk for recurrent relapses, against which pharmacological interventions are only partially effective. Further studies investigating predictors of relapse are needed to inform multi-disciplinary interventions for CMwMO.

A Qualitative Study On Patients With Chronic Migraine With Medication Overuse Headache: Comparing Frequent And Non‐Frequent Relapsers

“…This allowed them to seek help and maintain an optimistic outlook as to outcome. Previous research showed that patients with longer duration of CM had lower rates of internal control over pain and higher rates of attribution to external factors , and that increases in perceptions of internal control over pain (ie, being aware of individual responsibilities in chronification and of the importance of chance) were associated with successful withdrawal …”

“…Withdrawal is considered effective when a reduction of 50% in headache frequency is confirmed at 12 months, and research findings show an effectiveness of withdrawal up to 5 years after discharge . However, it is common clinical experience that some patients are more prone to relapse into MOH and to need further treatment after a shorter period than others, with 1‐year relapse rates found to be between 20.5 and 41% . The predictors of short‐term relapse include: high frequency of migraine attacks, recent history of withdrawal treatment, emergency room admission after withdrawal, high‐depression scores, residual symptomatology after withdrawal treatment and a greater number of previously tried preventive treatments, type of primary headache and type of overused medication, and a genetic predisposition for success of detoxification therapy and 12‐month relapse was also shown .…”

Predictors of 12‐Months Relapse After Withdrawal Treatment in Hospitalized Patients With Chronic Migraine Associated With Medication Overuse: A Longitudinal Observational Study

“…However, it is a common clinical practice experience that some patients seem to be more prone to fall again into MO and, thus, to be in need of further withdrawal treatment within a short‐term period. Few studies specifically addressed relapse rates: they showed that one‐year relapse rate ranged between 20.5% and 41%, and increased up to 45% by four years . In those studies that addressed 12‐months relapse, a total of 384 patients were included, and 126 relapsed, thus showing an average relapse rate of 32.8%.…”

“…In those studies that addressed 12‐months relapse, a total of 384 patients were included, and 126 relapsed, thus showing an average relapse rate of 32.8%. Predictor of relapse included: high‐frequency migraine (ie, >8 days/month), a lower reduction of headaches frequency after withdrawal treatment and a greater number of previously tried preventive treatments; type of primary headache and of overused medication, with migraineurs and in general patients overusing triptans having lower relapse rates; residual symptomatology; being on medical therapy only (compared to adjuvant behavioral technique) . A genetic predisposition, involving genetic variants of the catechol O‐methyltransferase and SLC6A4 genes, was also found .…”

“…On the contrary, data on the impact of psychosocial issues such as patients' disability, quality of life (QoL) and mood state – that have been found to be important correlates of CM‐MO – are basically lacking. Moreover, the definitions of relapse were not completely consistent across studies, and included relapse into medication overuse headache (ie, use of medications for acute treatment for more than 15 days/months for three months), relapse into CM‐MO or relapse into daily use of analgesic …”