Medication Overuse and Headache Burden

Abstract

Objective:To estimate the relative frequency of acute medication overuse (AMO) among people with episodic migraine (EM) and chronic migraine (CM), to characterize the types of acute medications overused for migraine, and to identify factors associated with AMO.Methods:We analyzed data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study (ClinicalTrials.gov, NCT01648530), a cross-sectional and longitudinal Internet study that included a systematic sampling of the US population. From September 2012 to November 2013, the CaMEO Study respondents participated in different modules to collect data on the clinical course of migraine, family burden, barriers to care, endophenotypes, and comorbidities. Among people who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition (ICHD-3), we evaluated types and frequency of medications used for headache/migraine, selected comorbidities, and emergency department (ED) and urgent care (UC) use. AMO was defined by days/month of medication use as specified by ICHD-3 criteria for medication overuse headache (MOH) without the requirement for ≥15 monthly headache days (MHDs). Nested, multivariable binary logistic regression modeling was used to identify factors associated with increased risk of AMO.Results:Of 16,789 CaMEO respondents with migraine, 2,975 (17.7%) met AMO criteria. Approximately 67.9% (2,021/2,975) of AMO respondents reported <15 MHDs. Simple analgesics, combination analgesics, and opioids were the medication classes most commonly overused. Factors associated with AMO in the final multivariable logistic regression model included ≥15 MHDs, moderate to severe disability, severe migraine interictal burden, use of preventive medication, and an ED/UC visit for headache within 6 months.Conclusions:Approximately two-thirds of respondents with AMO reported <15 MHDs and therefore did not meet criteria for MOH. Those with AMO had greater disease burden and increased ED/UC utilization relative to people with migraine but not AMO.

Candidate Genes and Proteomic Biomarkers of Serum and Urine in Medication-Overuse Headache

“…Moreover, the total cost for MOH patients is USD 10,179,000,000 annually in Iran [96]. A high economic burden for MOH was shown in other countries in the world as well [46,[97][98][99]. Thus, the worldwide personal and economic costs are enormous [15,100].…”

Abuse of medications for the treatment of migraines: results of an online survey

“…Также выявлена высокая частота использования средств для купирования ГБ: респонденты анализируемой группы в 62,7% случаев принимали обезболивающий препарат в каждом приступе ГБ, что указывает на высокий риск злоупотребления анальгетиками и возможного развития ЛИГБ. Данный вывод основывается на общепринятой в литературе точке зрения, что чрезмерное использование симптоматических средств является ключевым фактором формирования ЛИГБ [7][8][9][10]12], с одной стороны, а идентификация фактора злоупотребления анальгетиками свидетельствует о высоком риске хронификации мигрени с формированием ЛИГБ -с другой [1,2,14,16].…”

“…Пациенты с ЛИГБ характеризуются высоким уровнем дезадаптации и резким снижением качества жизни по сравнению с лицами без фактора медикаментозного злоупотребления [9]. По данным большого интернет-исследования CaMEO, среди 16 789 лиц с мигренью частота ЛИГБ составила 17,7%, среднее количество дней с ГБ -24,3 дня в месяц, а ежедневные ГБ отмечали 36,1% [10]. Пациенты с ЛИГБ отличались более высоким уровнем нарушения функционирования, более высокой частотой обращений за медицинской помощью и более низким качеством жизни в целом [10].…”

Treatment of chronic migraine with medication overuse: A perspective

“…Due to the high frequency and severity of migraine attacks, chronic migraine (CM) is often associated with overuse of as-needed medications. 1 It is well established that individuals who have CM associated with medication overuse (MO) should be offered migraine preventive therapy. However, there has been debate and clinical equipoise regarding the optimal recommendation for how to handle the overused as-needed medication when treating CM with MO.…”

“…There is evidence for several approaches: (1) preventive medication and stopping the overused medication, (2) preventive medication without stopping the overused medication, and (3) abrupt withdrawal ("detoxification") of the overused medication without preventive medication. 2 Although abrupt withdrawal of the overused medication without preventive medication may be effective in the short term, it is not a patient-centered approach and recidivism rates are high.…”