TY - JOUR

T1 - Psychological, clinical, and therapeutic predictors of the outcome of detoxification in a large clinical population of medication-overuse headache

T2 - A six-month follow-up of the COMOESTAS Project

AU - Bottiroli, Sara

AU - Allena, Marta

AU - Sances, Grazia

AU - De Icco, Roberto

AU - Avenali, Micol

AU - Fadic, Ricardo

AU - Katsarava, Zaza

AU - Lainez, Miguel J.A.

AU - Goicochea, Maria Teresa

AU - Bendtsen, Lars

AU - Jensen, Rigmor Højland

AU - Nappi, Giuseppe

AU - Tassorelli, Cristina

AU - the COMOESTAS Consortium

PY - 2019

Y1 - 2019

N2 - Aim: To identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache. Methods: Consecutive patients entering a detoxification program in six centres in Europe and Latin America were evaluated and followed up for 6 months. We evaluated anxious and depressive symptomatology (though patients with severe psychiatric comorbidity were excluded), quality of life, headache-related disability, headache characteristics, and prophylaxis upon discharge. Results: Of the 492 patients who completed the six-month follow up, 407 ceased overuse following the detoxification (non overusers), another 23 ceased overuse following detoxification but relapsed during the follow-up. In the 407 non-overusers, headache acquired an episodic pattern in 287 subjects (responders). At the multivariate analyses, lower depression scores (odds ratio = 0.891; p = 0.001) predicted ceasing overuse. The primary headache diagnosis – migraine with respect to tension-type headache (odds ratio = 0.224; p = 0.001) or migraine plus tension-type headache (odds ratio = 0.467; p = 0.002) – and the preventive treatment with flunarizine (compared to no such treatment) (odds ratio = 0.891; p = 0.001) predicted being a responder. A longer duration of chronic headache (odds ratio = 1.053; p = 0.032) predicted relapse into overuse. Quality of life and disability were not associated with any of the outcomes. Conclusions: Though exploratory in nature, these findings point to specific factors that are associated with a positive outcome of medication-overuse headache management, while identifying others that may be associated with a negative outcome. Evaluation of the presence/absence of these factors may help to optimize the management of this challenging groups of chronic headache sufferers.

AB - Aim: To identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache. Methods: Consecutive patients entering a detoxification program in six centres in Europe and Latin America were evaluated and followed up for 6 months. We evaluated anxious and depressive symptomatology (though patients with severe psychiatric comorbidity were excluded), quality of life, headache-related disability, headache characteristics, and prophylaxis upon discharge. Results: Of the 492 patients who completed the six-month follow up, 407 ceased overuse following the detoxification (non overusers), another 23 ceased overuse following detoxification but relapsed during the follow-up. In the 407 non-overusers, headache acquired an episodic pattern in 287 subjects (responders). At the multivariate analyses, lower depression scores (odds ratio = 0.891; p = 0.001) predicted ceasing overuse. The primary headache diagnosis – migraine with respect to tension-type headache (odds ratio = 0.224; p = 0.001) or migraine plus tension-type headache (odds ratio = 0.467; p = 0.002) – and the preventive treatment with flunarizine (compared to no such treatment) (odds ratio = 0.891; p = 0.001) predicted being a responder. A longer duration of chronic headache (odds ratio = 1.053; p = 0.032) predicted relapse into overuse. Quality of life and disability were not associated with any of the outcomes. Conclusions: Though exploratory in nature, these findings point to specific factors that are associated with a positive outcome of medication-overuse headache management, while identifying others that may be associated with a negative outcome. Evaluation of the presence/absence of these factors may help to optimize the management of this challenging groups of chronic headache sufferers.

KW - anxiety

KW - depression

KW - disability

KW - quality of life

KW - relapse

KW - Withdrawal

U2 - 10.1177/0333102418783317

DO - 10.1177/0333102418783317

M3 - Journal article

C2 - 29945464

AN - SCOPUS:85049882272

VL - 39

SP - 135

EP - 147

JO - Cephalalgia

JF - Cephalalgia

SN - 0800-1952

IS - 1

ER -