The added value of an electronic monitoring and alerting system in the management of medication-overuse headache: A controlled multicentre study

Abstract

Background Medication-overuse headache (MOH) is a chronic disabling condition associated with a high rate of relapse. Methods We evaluated whether the adoption of electronic-assisted monitoring, advice and communication would improve the outcome over a follow-up of 6 months in a controlled, multicentre, multinational study conducted in six headache centres located in Europe and Latin America. A total of 663 MOH subjects were enrolled and divided into two groups: the Comoestas group was monitored with an electronic diary associated with an alert system and a facilitated communication option, and the Classic group with a paper headache diary. Results We observed a significantly higher percentage of overuse-free subjects in the Comoestas group compared with the Classic group: 73.1 vs 64.1% (odds ratio 1.45, 95% confidence interval 1.07-2.09, p = 0.046). The Comoestas group performed better also regarding the number of days/month with intake of acute drugs and the level of disability [Migraine Disability Assessment Score: Comoestas group - 42.5 ± 53.6 (35.5-49.3) and Classic group - 27.5 ± 56.1 (20.6-34.3) ( p < 0.003)]. Conclusion The adoption of the electronic tool improved the outcome of patients suffering from MOH after withdrawal from overused drugs. Information and communication technology represents a valid aid for optimizing the management of chronic conditions at risk of worsening or of relapsing. Trial registration The trial was registered at ClinicalTrials.gov (no. NCT02435056).

Clinical Subtypes of Medication Overuse Headache – Findings From a Large Cohort

“…15 A recent study on 128 patients by Seo and Park showed that depression is a risk factor for frovatriptan inefficacy in patients with migraine, 23 suggesting possible negative selection for depression in T treated group. This finding may be a reflection of a better acute efficacy of these drugs, which could contribute to make the patients feel more in control of their disease.…”

“…However, HADS has been adopted in many studies 15,[24][25][26][27] and represented the best trade-off for capturing comparable data on the psychological condition of such a large and distributed population of MOH. Moreover, this group of patients was selected according to specific inclusion and exclusion criteria in order to ensure population homogeneity within the main clinical trial (COMOESTAS study), which limits the generalizability of our findings to more severely affected or comorbid MOH subjects.…”

“…We also evaluated migrainerelated disability using the MIDAS questionnaire that rates disability into 4 grades: minimal (0-5), mild (6-10), moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), or severe (>21). We also evaluated migrainerelated disability using the MIDAS questionnaire that rates disability into 4 grades: minimal (0-5), mild (6-10), moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20), or severe (>21).…”

“…In the ICHDclassification, indeed, the headache of MOH is qualitatively undifferentiated in its presentation, being merely qualified by the sum of headache days and days of intake of acute medications. 15 The aim of this study is to investigate whether MOH subtypes are associated with specific demographic or phenotypical characteristics. 13,14 In one of these studies, the focus was limited to temporal variables, 13 in the other it was restricted to the comparison of two subtypes of T-MOH, 14 both studies the population under evaluation was quite small and limited to a single Country.…”

Treatment of medication overuse headache—A review

“…The comparative studies of having the support of a headache nurse, 40 an electronic diary, 41 and receiving psychotherapy all have in common that the patients received close follow-up or had the possibility to contact the clinic and for the staff to direct the treatment more to the specific MOH patient-that is, give a more personalized treatment. The comparative studies of having the support of a headache nurse, 40 an electronic diary, 41 and receiving psychotherapy all have in common that the patients received close follow-up or had the possibility to contact the clinic and for the staff to direct the treatment more to the specific MOH patient-that is, give a more personalized treatment.…”