Medication overuse headache in 787 patients admitted for inpatient treatment over a period of 32 years

Abstract

Background Definitions of medication overuse headache have changed over time. Objective To evaluate the clinical characteristics of medication overuse headache patients admitted for inpatient withdrawal therapy over a period of 32 years. Methods We included all patients with medication overuse headache treated from 1 January 1984 to 31 December 2015. We obtained all data from the medical reports and defined three periods, P1 (1984–1993), P2 (1994–2003), and P3 (2004–2015). The p-value adjusted for multiple comparisons was set to 0.005. Results Within 32 years, a total of 787 patients accounted for 904 admissions for MOH. From P1 to P3, the proportion of patients with preexisting migraine increased from 44.3% to 53.3% (chi2 = 9.0, p = 0.01) and that with preexisting tension-type headache decreased from 47.9% to 34.6% (chi2 = 9.3, p < 0.01). The median time since onset of headache and medication overuse headache decreased from 20 to 15 years ( p < 0.001) and from 3 to 2 years ( p < 0.001). The median cumulative number of single doses decreased from 120 to 90 per month ( p = 0.002). Overuse of triptans, non-opioid analgesics, and opioids increased, whereas overuse of ergotamines decreased over time ( p < 0.001 for all tests). The use of prophylactic medication before admission increased from 8.3% to 29.9% (chi2 = 89.5, p < 0.001). Conclusion This retrospective study in a large number of patients with medication overuse headache admitted for inpatient withdrawal therapy over a period of 32 years shows a trend towards changes in the preexisting headache type, a decrease in the time since onset of headache and medication overuse headache, a decrease in the number of drug doses used per month, changes in the type of drugs overused, and an increase in, but still low rate, of prophylactic medication prior to admission.

Medication-Overuse Headache (Review of Literature and Recommendations for Practice)

“…пациенты наиболее часто пользовались простыми анальгетиками (54,4 %) и комбинированными анальгетиками (33,5 %), реже триптанами (31,9 %) и препаратами эрготамина (8,2 %). Вместе с тем у 53 % пациентов диагностировано злоупотребление двумя или более классами препаратов [8]. Изучается также и риск развития ЛИГБ при приеме новых классов препаратов для купирования приступа мигрени -дитанов (не зарегистрированы в России) [9].…”

“…НПВС и парацетамол считаются препаратами с меньшим риском развития ЛИГБ, в то время как триптаны приводят к развитию ЛИГБ быстро. Однако головная боль, связанная со злоупотреблением триптанами, быстрее, с более коротким периодом «головных болей отмены», отвечает на терапию [8,10,11].…”

“…Такие программы могут проводиться как амбулаторно, так и в стационаре. Краткосрочное лечение в стационаре в особенности показано пациентам с коморбидными депрессией и тревогой, а также с хроническими стрессовыми ситуациями [8]. В первые дни после отмены симптоматических препаратов для облегчения «симптомов отмены» могут назначаться напроксен, ацетаминофен, прометазин, метоклопрамид.…”

Therapies targeting CGRP signaling for medication overuse headache

“…MOH only develops in individuals with a preexisting primary headache disorder, most frequently migraine or tension-type headache (TTH), after excessive use of acute symptomatic medications (regular consumption on 10 or more, for 15 or more days/month, depending on the medication). The medication overuse (MO) increases the frequency and may change the phenomenology of the preexisting headaches developing a new headache type [4]. MOH is linked to baseline frequency of headache attacks, the class and the frequency of symptomatic medication ingested, and other risk factors.…”

Analgesic efficacy of a portable, disposable, and self‐applied transcutaneous electrical nerve stimulation device during migraine attacks: A real‐life randomized controlled trial

“…The excessive use of analgesics drugs to manage pain during migraine attacks may paradoxically contribute to chronic headaches and severely impact quality of life 2,3 . The excessive use of analgesics, particularly opioid‐based drugs that are not indicated for migraine attacks, are also frequently associated with serious adverse effects 4,5 . To circumvent side effects arising from pharmacological treatments, patients and specialists have resorted to nonpharmacological therapies to minimize the use of analgesic drugs during migraine attacks 2,3 …”