Prevention of medication overuse in patients with migraine

Abstract

This multi-center study compared the therapeutic effect of a cognitive-behavioral minimal contact program (MCT) to the effect of a brochure (bibliotherapy) for the prevention of medication overuse headache (MOH) in migraine patients. Seven German headache centers recruited 182 migraine patients with high triptan or analgesic intake frequency. Patients were randomly allocated to either the MCT-group, receiving both an MCT program and an educational brochure or to the biblio-group receiving only the brochure. All participants continued usual medical treatment. Course of headaches, intake of analgesics or triptans after training, 3 months post-training as well as 1-2 years (mean 15.7 months) later and psychological variables were defined as outcome variables. A significant decline was observed in the number of headache days (11.0-8.8), migraine days (7.3-5.7) and medication intake days (7.4-6.1) from pre to post in the MCT-group (p<0.001 each) and in the biblio-group (p<0.001 each). The pre-to-post-improvements were maintained from pre- to short- and from pre- to long-term follow-up (p<0.001 each) in both groups. Both groups improved significantly from pre to post in psychological variables, e.g. pain acceptance: p<0.001; pain catastrophizing: p<0.001; functional pain coping: p<0.001; and pain related internal control beliefs: p<0.01. Psychological improvements remained stable in both groups at short- and long-term follow-up. During the study, none of the patients developed an MOH. MCT- and bibliotherapy are useful in migraine patients to prevent medication overuse headache or the transition of episodic to chronic headache.

Psychological and neuropsychological correlates of dependence-related behaviour in Medication Overuse Headaches: a one year follow-up study

“…In the field of headaches, it has been showed that subjects with chronic daily headaches exhibit increased catastrophizing scores when compared to episodic migraineurs, higher catastrophizing being associated with lower quality of life [15]. Moreover the prevention of MOH in high frequency migraine patients by a cognitive behavioural program is associated with a lowering of catastrophizing [16]. …”

Update on Medication-overuse Headache

“…Recent studies support the idea that frequent intake of antimigraine drugs is caused not only by the intensity of headache pain and frequency of the attacks, but also by fear and loss of social function, observations highlighting the importance that psychology can have on intake behavior [2]. Comorbidity of anxiety and depression frequently exists in patients with chronic daily headache [2].…”

Integrated multidisciplinary care of headache disorders: A narrative review

“…For example, in Denmark main topics are imparted by headache nurses whereas in Germany predominantly doctors and psychologists conduct patient education sessions. In an outpatient setting with a focus on education, written information (bibliotherapy) might be as useful as cognitive-behavioral group sessions that could be shown in a randomized clinical trial with patients at risk for MOH (27).…”