Sara Bottiroli1, Marta Allena1, Grazia Sances1, Roberto De Icco1,2, Micol Avenali1,2, Ricardo Fadic3, Zaza Katsarava4, Miguel Ja Lainez5, Maria Teresa Goicochea6, Lars Bendtsen7, Rigmor Højland Jensen7, Giuseppe Nappi1, Cristina Tassorelli1,2. 1. 1 Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy. 2. 2 Department of Brain and Behavioral Sciences, University of Pavia, Italy. 3. 3 Department of Neurology, Pontificia Catolica University of Chile, Santiago, Chile. 4. 4 Department of Neurology, University of Essen, Germany. 5. 5 Foundation of the Valencian Community, University Clinical Hospital, Spain. 6. 6 Integral Pain Centre, Fundación para la Lucha contra las Enfermedades Neurológicas Infantiles (FLENI), Buenos Aires, Argentina. 7. 7 Danish Headache Centre, Department of Neurology, Glostrup Hospital, Glostrup, Denmark.
Abstract
AIM: To identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache. METHODS: Consecutive patients entering a detoxification program in six centres in Europe and Latin America were evaluated and followed up for 6 months. We evaluated anxious and depressive symptomatology (though patients with severe psychiatric comorbidity were excluded), quality of life, headache-related disability, headache characteristics, and prophylaxis upon discharge. RESULTS: Of the 492 patients who completed the six-month follow up, 407 ceased overuse following the detoxification (non overusers), another 23 ceased overuse following detoxification but relapsed during the follow-up. In the 407 non-overusers, headache acquired an episodic pattern in 287 subjects (responders). At the multivariate analyses, lower depression scores (odds ratio = 0.891; p = 0.001) predicted ceasing overuse. The primary headache diagnosis - migraine with respect to tension-type headache (odds ratio = 0.224; p = 0.001) or migraine plus tension-type headache (odds ratio = 0.467; p = 0.002) - and the preventive treatment with flunarizine (compared to no such treatment) (odds ratio = 0.891; p = 0.001) predicted being a responder. A longer duration of chronic headache (odds ratio = 1.053; p = 0.032) predicted relapse into overuse. Quality of life and disability were not associated with any of the outcomes. CONCLUSIONS: Though exploratory in nature, these findings point to specific factors that are associated with a positive outcome of medication-overuse headache management, while identifying others that may be associated with a negative outcome. Evaluation of the presence/absence of these factors may help to optimize the management of this challenging groups of chronic headache sufferers.
AIM: To identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache. METHODS: Consecutive patients entering a detoxification program in six centres in Europe and Latin America were evaluated and followed up for 6 months. We evaluated anxious and depressive symptomatology (though patients with severe psychiatric comorbidity were excluded), quality of life, headache-related disability, headache characteristics, and prophylaxis upon discharge. RESULTS: Of the 492 patients who completed the six-month follow up, 407 ceased overuse following the detoxification (non overusers), another 23 ceased overuse following detoxification but relapsed during the follow-up. In the 407 non-overusers, headache acquired an episodic pattern in 287 subjects (responders). At the multivariate analyses, lower depression scores (odds ratio = 0.891; p = 0.001) predicted ceasing overuse. The primary headache diagnosis - migraine with respect to tension-type headache (odds ratio = 0.224; p = 0.001) or migraine plus tension-type headache (odds ratio = 0.467; p = 0.002) - and the preventive treatment with flunarizine (compared to no such treatment) (odds ratio = 0.891; p = 0.001) predicted being a responder. A longer duration of chronic headache (odds ratio = 1.053; p = 0.032) predicted relapse into overuse. Quality of life and disability were not associated with any of the outcomes. CONCLUSIONS: Though exploratory in nature, these findings point to specific factors that are associated with a positive outcome of medication-overuse headache management, while identifying others that may be associated with a negative outcome. Evaluation of the presence/absence of these factors may help to optimize the management of this challenging groups of chronic headache sufferers.
Entities:
Keywords:
Withdrawal; anxiety; depression; disability; quality of life; relapse
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