E S Kristoffersen1,2,3, J Straand1, M B Russell4,5, C Lundqvist2,3,4. 1. Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway. 2. HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway. 3. Department of Neurology, Akershus University Hospital, Lørenskog, Norway. 4. Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway. 5. Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.
Abstract
BACKGROUND AND PURPOSE:Withdrawal therapy improves the headache situation for many patients with medication-overuse headache (MOH), but relapses are common. The objective was to assess the long-term effectiveness of a general practitioner conducted brief intervention (BI) for MOH. METHODS:Sixty MOH patients initially participating in a blinded cluster-randomized controlled trial evaluating BI versus business as usual (BAU) were followed up for 16 months. Follow-up was open after 6 months. Headache and medication days per month were evaluated in three groups: BI early (BI throughout the study, n = 24), BI late (initial BAU, then cross-over to BI, n = 22) and BAU throughout the study (n = 14). RESULTS:Fifty-five of 60 initially included patients completed the follow-up. The mean change over 16 months' observation in the BI early group was a reduction of 8.4 (5.4-11.4) headache and 13.5 (9.6-17.3) medication days per month. The relapse rate into medication overuse was 8.3%. Patients in the BI late group also improved significantly after a BI. BAU showed no significant improvement. CONCLUSIONS: Treatment for MOH in primary care through a BI is a simple intervention with lasting effects and low relapse rate. This approach may be a logical first step in MOH treatment, and referral should generally be reserved for primary care non-responders.
RCT Entities:
BACKGROUND AND PURPOSE: Withdrawal therapy improves the headache situation for many patients with medication-overuse headache (MOH), but relapses are common. The objective was to assess the long-term effectiveness of a general practitioner conducted brief intervention (BI) for MOH. METHODS: Sixty MOH patients initially participating in a blinded cluster-randomized controlled trial evaluating BI versus business as usual (BAU) were followed up for 16 months. Follow-up was open after 6 months. Headache and medication days per month were evaluated in three groups: BI early (BI throughout the study, n = 24), BI late (initial BAU, then cross-over to BI, n = 22) and BAU throughout the study (n = 14). RESULTS: Fifty-five of 60 initially included patients completed the follow-up. The mean change over 16 months' observation in the BI early group was a reduction of 8.4 (5.4-11.4) headache and 13.5 (9.6-17.3) medication days per month. The relapse rate into medication overuse was 8.3%. Patients in the BI late group also improved significantly after a BI. BAU showed no significant improvement. CONCLUSIONS: Treatment for MOH in primary care through a BI is a simple intervention with lasting effects and low relapse rate. This approach may be a logical first step in MOH treatment, and referral should generally be reserved for primary care non-responders.
Authors: Hans-Christoph Diener; Peter Kropp; Thomas Dresler; Stefan Evers; Stefanie Förderreuther; Charly Gaul; Dagny Holle-Lee; Arne May; Uwe Niederberger; Sabrina Moll; Christoph Schankin; Christian Lampl Journal: Neurol Res Pract Date: 2022-08-29
Authors: Anna Letícia Moraes Alves; Izadora Karina Silva; Pedro Henrique Paula Lemos; Victor Lomachinsky Torres; Eric Crevanzi Arraes; Pedro Augusto Sampaio Rocha-Filho Journal: Acta Neurol Belg Date: 2021-07-23 Impact factor: 2.396