Determinants of pain interference and headache impact in patients who have chronic migraine with medication overuse: Results from the MOTS trial

Abstract

Objective “Pain interference” and “headache impact” refer to negative consequences that pain and headache have on one’s life. This study investigated determinants of these negative impacts in a large patient cohort who have chronic migraine with medication overuse. Methods Six hundred and eleven adults were enrolled from 34 headache, neurology, and primary care clinics. Negative consequences of chronic migraine with medication overuse were determined using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference 6b questionnaire and the Headache Impact Test 6. Relationships between PROMIS-6b and Headache Impact Test 6 scores with demographics, headache characteristics, medication use, anxiety symptoms, and depression symptoms were assessed with linear regression. Elastic Net regression was used to develop a multiple regression model. Results PROMIS-6b T-Scores averaged 65.2 (SD 5.4) and Headache Impact Test 6 scores averaged 65.0 (SD 5.3), indicating severe negative consequences of chronic migraine with medication overuse. Chronic migraine with medication overuse interfered with enjoyment of life, concentration, daily activities, doing tasks away from home, and socializing. Depression symptom severity had the strongest relationship with pain interference and headache impact. Moderate-to-severe headache frequency, headache intensity, and anxiety symptoms were also associated with pain interference and headache impact. Conclusions Chronic migraine with medication overuse is associated with substantial negative consequences, the extent of which is most strongly related to depression symptoms.

Clinical characteristics of medication‐overuse headache according to the class of acute medication: A cross‐sectional multicenter study

“…Our study differs from the previous Medication OveruseTreatment Strategy study in the United Sates and the Continuous Monitoring of Medication Overuse Headache in Europe and Latin America project 33,34. Owing to sociocultural, economic, geographical, medical service-related, institutional, and racial differences between countries, the results of this study cannot be generalized.…”

Prediction and associated factors of non-steroidal anti-inflammatory drugs efficacy in migraine treatment

“…Migraine-induced disability and reduced quality of life, measured by the MIDAS and HIT-6 questionnaires, are the main reference indexes for assessing therapeutic efficacy ( Alpuente et al, 2020 ; Chen et al, 2015 ) and the main factors driving patients to seek appropriate care ( Lipton et al, 2013 ). Moreover, headache frequency, headache intensity and psychiatric symptoms were also associated with pain interference and headache impact ( Schwedt et al, 2021 ). Our results revealed significant differences in migraine disability between the responders and non-responders.…”

Classification and Diagnosis of Primary Headache Disorders

“…It has been suggested that rather than as a cause, frequent use of acute medications can better be viewed (at least in some patients) as an indication of disease progression which leads to an increasing need for acute treatment 29 . Studies of treatment strategies in MOH have begun to shed more light on these complex issues 30 . One of the most notable observations about MOH is that it seems to be primarily a condition seen in migraine and possibly TTHA.…”

“…29 Studies of treatment strategies in MOH have begun to shed more light on these complex issues. 30 One of the most notable observations about MOH is that it seems to be primarily a condition seen in migraine and possibly TTHA. Therefore, if medication overuse is a causal factor in migraine “chronification,” we might consider the condition a subset of the primary headache disorder—say “CM with medication overuse.”…”