Prescription pain medications and chronic headache in Denmark: implications for preventing medication overuse
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The aim of the present paper is to study which prescription pain medications are most commonly dispensed to people with chronic headache (CH), particularly those with medication-overuse headache (MOH).
This cross-sectional study analysed prescription pain medications dispensed within 1 year to 68,518 respondents of a national health survey. Participants with headache ≥15 days per month for 3 months were classified as having CH. Those with CH and over-the-counter analgesic use ≥15 days per month or purchase of ≥20 or ≥30 defined daily doses (DDDs) of prescription pain medication per month (depending on the drug) were classified as having MOH. Associations between CH and other chronic pain conditions were analysed by logistic regression.
Among those with CH (adjusted prevalence 3.3 %, CI 3.2–3.5 %), pain medications most commonly dispensed were paracetamol, tramadol, ibuprofen and codeine. CH was associated with osteoarthritis, back pain, and rheumatoid arthritis. Among those with MOH, 32.4 % were dispensed an opioid at least once within 1 year. Only 5.1 % of people with CH were dispensed triptans.
High prevalence of opioid use among people with CH may be due to inappropriate headache treatment or development of MOH among those treated for other pain conditions. While there were cases of triptan overuse, triptans remain underutilized among those with CH, suggesting that migraine may be under-recognized and inappropriately treated, leading to overuse of other medications. Education of physicians on appropriate headache management is essential for MOH prevention. There is a need to increase universal awareness about MOH as an adverse effect of long-term analgesic use.
KeywordsPharmacoepidemiology Analgesics Triptans Opioids Chronic headache Secondary headache disorders Medication-overuse headache
The authors thank the Research Centre for Prevention and Health, especially data manager Carsten Agger, and the team responsible for the Danish National Health Survey; Inger Helt Poulsen for facilitating use of data from Region Zealand; and Statistics Denmark for management of the raw data. Furthermore, we thank everyone who responded to the surveys.
This study did not receive corporate sponsorship. The Region Zealand Health Profile 2010 and The Capital Region Health Profile 2010 were funded by The Region Zealand and The Capital Region of Denmark. MW received research grants from IMK Almene Fond and the patient organization Migræne og Hovedpineforeningen in connection with this study.
Conflict of interest statement
MW received travel grants from Pfizer, Lundbeck Fund, and Allergan to attend international conferences. RJ has given lectures for Pfizer, Berlin-Chemie, Allergan, Merck, and Autonomic Technologies; is a member of the advisory boards of Autonomic Technologies, Medotech, and Neurocore; and is co-director of Lifting The Burden and EHMTIC. EHH and CG declare that they have no conflict of interest.
MLW preformed the drafting and revising the manuscript, study concept, statistical analysis, and interpretation of data; EHH for revising the manuscript, study concept, interpretation of data, and study supervision; CG for revising the manuscript, study design, acquisition and interpretation of data, obtaining funding, study supervision, and coordination; and RHJ for revising the manuscript, study concept and design, interpretation of data, obtaining funding, study supervision, and coordination.
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