Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project)

Bendtsen, Lars; Munksgaard, Signe Bruun; Tassorelli, Cristina; Nappi, Giuseppe; Katsarava, Zaza; Láinez, Miguel J. A.; Leston, Jorge; Fadić, Ricardo; Spadafora, Santiago; Stoppini, A; Jensen, Rigmor Højland

doi:10.1177/0333102413515338

Cited by 115 publications

(134 citation statements)

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“…Notably, within the group of subjects who discontinued medication overuse and presented at 1-year follow-up with episodic migraine, significant improvements generalized from migraine characteristics to untreated domains, including decreased depressive symptoms, headache related disability, and dependency-like behaviors [13]. In contrast, subjects who relapsed into CMwMO did not show clinical or psychological improvements, instead reporting increased anxiety and unmodified perpetuation of severe dependency-like behaviors.…”

Section: Discussionmentioning

confidence: 99%

“…Although the characteristics of CMwMO are considered to be outcome predictors associated with relapse [11,12], longitudinal studies showed that neither the frequency nor the intensity of migraines is significantly associated with relapse rates [10], instead suggesting that psychological and affective characteristics could play a key role. Mood disorders including depression have been considered relapse-predicting factors [13]: a 4-year follow-up study conducted by Hagen et al found that lower scores for depressive symptoms at baseline were the only factor associated with functional improvement [14]. Furthemore, dysfunctional personality traits have been related to worsened long-term prognosis in subjects with CM , and might facilitate the perpetuation of medication consumption [15,16].…”

Section: Introductionmentioning

confidence: 99%

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

Biagianti

Grazzi²,

Usai³

et al. 2014

BMC Neurol

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Biagianti

Grazzi²,

Usai³

et al. 2014

BMC Neurol

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“…Disability measured with the Migraine Disability Assessment (MIDAS) questionnaire is high in MOH 66,68–70. In the recent Global Burden of Disease Study,4 MOH was not a part of the final analysis.…”

Section: Societal Consequences Of Mohmentioning

confidence: 99%

Medication-overuse headache: a review

Kristoffersen

Lundqvist²

2014

JPR

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Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1%–2%. It is a severe form of headache where the patients often have a long history of headache and of unsuccessful treatments. MOH is characterized by chronic headache and overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This review focuses on aspects of epidemiology, diagnosis, pathogenesis, prevention, and treatment of MOH. We suggest that information and education about the risk of MOH is important since the condition is preventable. Most patients experience reduction of headache days and intensity after successful treatment. The first step in the treatment of MOH should be carried out in primary care and focus primarily on withdrawal, leaving prophylactic medication to those who do not manage primary detoxification. For most patients, a general practitioner can perform the follow-up after detoxification. More complicated cases should be referred to neurologists and headache clinics. Patients suffering with MOH have much to gain by an earlier treatment-focused approach, since the condition is both preventable and treatable.

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“…The outcome was even better after complete discontinuation than low-dose caffeine consumption. Taken together, our study results might indicate that migraine patients may benefit from complete abstinence of caffeine, similarly to the abrupt discontinuation of acute analgesics for detoxification in patients with medication overuse headache [20, 21]. …”

Section: Discussionmentioning

confidence: 91%

Caffeine discontinuation improves acute migraine treatment: a prospective clinic-based study

Lee

Choi

et al. 2016

J Headache Pain

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BackgroundCaffeine has both excitatory and vasoconstrictive effects on central nervous system. Caffeine use might be associated with development and chronification of migraine. We aimed to evaluate the effect of caffeine cessation on the acute treatment of migraine.MethodsWe prospectively recruited migraine patients who consumed caffeine drinks daily and instructed them to discontinue their caffeine intake. Triptans were prescribed for acute treatment. Patients were followed up after at least two weeks after screening and evaluated the efficacy of acute treatment with the migraine assessment of current therapy (Migraine-ACT) questionnaire. Excellent efficacy was defined as Migraine-ACT score of 4. Chronic migraine, body mass index, allodynia, depression, anxiety, antiemetic use, and use of prophylactic medication were included in the multivariate analysis if the univariate p < 0.2.FindingsAmong 108 patients included, 36 completely discontinued their caffeine intake (abstinence group). The efficacy of acute treatment was assessed at median 34.5 days (interquartile range, 28–89) after the screening. Twenty-six patients (72.2 %) in the abstinence group and 29 (40.3 %) in the non-abstinence group reported an excellent efficacy (p = 0.002). The abstinence group also showed a trend toward greater reduction of headache impact test-6 (HIT-6) scores (p = 0.085). Caffeine abstinence was independently associated with an excellent efficacy of acute treatment (multivariate odds ratio, 3.2; 95 % confidence interval, 1.2–8.4; p = 0.018) after controlling for covariates.ConclusionsCaffeine abstinence is associated with better efficacy of acute migraine treatment. Our uncontrolled study results encourage a further confirmatory study on this issue.

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Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project)

Cited by 115 publications

References 20 publications

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

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

Medication-overuse headache: a review

Caffeine discontinuation improves acute migraine treatment: a prospective clinic-based study

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