Medication overuse headache and its specific clinical markers

Abstract

Introduction: Clinical markers of medication overuse headache (MOH) are based on headache classification developed by the International Headache Society (IHS). This classification include only two criteria: 1) frequency of headache must be 15 or more days per month for at least three or more months; 2) the number of days of overuse medication must be either 10 or 15 days per month depending on the type of medication. However, patients often present with associated clinical markers that are overlooked by most physicians at the first visit. Methods: This is a prospective, longitudinal and observational study of 76 patients admitted to DIPRECA´s hospital Headache Unit. They were all diagnosed with MOH according to the criteria established by the his ICHD III beta. Patients were given standard therapeutic approach that included detoxification, prescription of preventative medications and a standardized follow-up of 6 months. Symptoms of interest were recorded at each appointment and Zung, MIDAS and HIT-6 (headache impact test) scales were applied. Results: Overused medications included nonsteroidal anti-inflammatory drugs (NSAIDs), triptans and ergots. The most significant associated features were headache at awakening, awaking by headache, attentional difficulties, depression, cervical pain and myofascial pain syndrome. All symptoms improved with therapy as well as MIDAS and HIT-6 scores. Discussion: In evaluating patients with MOH consider both the ICHD III beta diagnostic criteria and the common and specific symptoms seen in most cases of MOH.

Confirmatory factor analysis of the brief Spanish Zung Self‐Rating Depression Scale in patients with chronic pulmonary obstructive disease

“…Besides, it was observed that the scale compared with a structured clinical interview, for a cutoff point of 20/40, showed a sensitivity of 95.5%, a specificity of 70.3%, a positive predictive value of 38.9%, a value negative predictive of 98.7%, positive probability ratio of 3.2, negative probability ratio of 0.07, Cohen's kappa of 0.42, and area under the curve of 0.90; similar to the original 20‐item version 10 . Therefore, the Brief Spanish Zung Self‐Rating Depression Scale has been used to quantify depressive symptoms in other studies in Latin America 11‐15 …”