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Journal of Neurology

, Volume 263, Issue 2, pp 344–353 | Cite as

Brief intervention by general practitioners for medication-overuse headache, follow-up after 6 months: a pragmatic cluster-randomised controlled trial

  • Espen Saxhaug KristoffersenEmail author
  • Jørund Straand
  • Kjersti Grøtta Vetvik
  • Jūratė Šaltytė Benth
  • Michael Bjørn Russell
  • Christofer Lundqvist
Original Communication

Abstract

Medication-overuse headache (MOH) is a common health problem. Withdrawal of the overused medication is the treatment of choice. We investigated the long-term effectiveness of brief intervention (BI) for MOH patients in primary care. The BI for MOH in primary care study was a blinded, pragmatic, cluster-randomised controlled trial. 25,486 patients (age 18–50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and 23 GPs were randomised to receive BI training and 27 GPs to continue business as usual (BAU). The GPs assessed their MOH patients with the Severity of Dependence Scale, gave individual feedback about the risk of MOH and advice to reduce headache medication. Primary outcomes, assessed 6 months after the intervention, were reduction in headache and medication days/month. 42 % were screening responders. 2.4 % had self-reported MOH. A random selection of 104 patients with self-reported MOH were invited, 75 were randomised out of which 60 with a physician-defined MOH diagnosis were included. None were lost to follow-up. BI was significantly better than BAU regarding primary outcomes (p < 0.001–0.018). Headache and medication days were reduced by 5.9 (95 % CI 1.1–10.8) and 6.2 (1.1–11.3) more days/month in BI than BAU group. Chronic headache resolved in 63 and 11 % in the BI and the BAU group (p < 0.001). Headache-related disability was lower among those who detoxified. In conclusion, BI is an effective treatment in primary care with lasting effect 6 months after the intervention for MOH.

Trial Registration: ClinicalTrials.gov identifier: NCT01314768.

Keywords

Medication-overuse headache Migraine Screening and brief intervention General practice Severity of dependence scale Cluster-randomised trial 

Notes

Acknowledgments

The authors want to express our sincere gratitude to all participating patients and GPs, without them the study would not have been possible. Thanks also for logistic help from the research administration at Akershus University Hospital.

Compliance with ethical standards

Funding

This study is supported by grants from the University of Oslo, the Research Centre at Akershus University Hospital and the South-Eastern Norway Regional Health Authority. The funding sources had no role in the design of the study; the collection, analysis, and interpretation of the data, preparation of the manuscript; or the decision to submit the manuscript for publication.

Conflicts of interest

All authors have completed the ICMJE uniform disclosure form and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 2 years; no other relationships or activities that could appear to have influenced the submitted work.

References

  1. 1.
    Evers S, Marziniak M (2010) Clinical features, pathophysiology, and treatment of medication-overuse headache. Lancet Neurol 9:391–401CrossRefPubMedGoogle Scholar
  2. 2.
    Colás R, Muñoz P, Temprano R, Gómez C, Pascual J (2004) Chronic daily headache with analgesic overuse: epidemiology and impact on quality of life. Neurology 62:1338–1342CrossRefPubMedGoogle Scholar
  3. 3.
    Linde M, Gustavsson A, Stovner LJ, Steiner TJ, Barre J, Katsarava Z, Lainez JM, Lampl C, Lanteri-Minet M, Rastenyte D, Ruiz de la Torre E, Tassorelli C, Andree C (2012) The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol 19:703–711CrossRefPubMedGoogle Scholar
  4. 4.
    Bendtsen L, Munksgaard S, Tassorelli C, Nappi G, Katsarava Z, Lainez M, Leston J, Fadic R, Spadafora S, Stoppini A, Jensen R (2014) Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project). Cephalalgia 34:426–433CrossRefPubMedGoogle Scholar
  5. 5.
    Aaseth K, Grande RB, Kvaerner KJ, Gulbrandsen P, Lundqvist C, Russell MB (2008) Prevalence of secondary chronic headaches in a population-based sample of 30 to 44-year-old persons. The Akershus study of chronic headache. Cephalalgia 28:705–713CrossRefPubMedGoogle Scholar
  6. 6.
    Evers S, Jensen R (2011) Treatment of medication overuse headache–guideline of the EFNS headache panel. Eur J Neurol 18:1115–1121CrossRefPubMedGoogle Scholar
  7. 7.
    Chiang CC, Schwedt TJ, Wang SJ, Dodick DW (2015) Treatment of medication-overuse headache: a systematic review. Cephalalgia (Epub ahead of print) Google Scholar
  8. 8.
    Jonsson P, Jakobsson A, Hensing G, Linde M, Moore CD, Hedenrud T (2013) Holding on to the indispensable medication–a grounded theory on medication use from the perspective of persons with medication overuse headache. J Headache Pain 14:43CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Minen MT, Loder E, Tishler L, Silbersweig D (2015) Migraine diagnosis and treatment: a knowledge and needs assessment among primary care providers. Cephalalgia (Epub ahead of print) Google Scholar
  10. 10.
    Grande RB, Aaseth K, Benth JS, Lundqvist C, Russell MB (2011) Reduction in medication-overuse headache after short information. The Akershus study of chronic headache. Eur J Neurol 18:129–137CrossRefPubMedGoogle Scholar
  11. 11.
    Rossi P, Faroni JV, Nappi G (2011) Short-term effectiveness of simple advice as a withdrawal strategy in simple and complicated medication overuse headache. Eur J Neurol 18:396–401CrossRefPubMedGoogle Scholar
  12. 12.
    Rossi P, Faroni JV, Tassorelli C, Nappi G (2013) Advice alone versus structured detoxification programmes for complicated medication overuse headache (MOH): a prospective, randomized, open-label trial. J Headache Pain 14:10CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Andrasik F, Grazzi L, Usai S, Kass S, Bussone G (2010) Disability in chronic migraine with medication overuse: treatment effects through 5 years. Cephalalgia 30:610–614CrossRefPubMedGoogle Scholar
  14. 14.
    Ghiotto N, Sances G, Galli F, Tassorelli C, Guaschino E, Sandrini G, Nappi G (2009) Medication overuse headache and applicability of the ICHD-II diagnostic criteria: 1-year follow-up study (CARE I protocol). Cephalalgia 29:233–243CrossRefPubMedGoogle Scholar
  15. 15.
    Katsarava Z, Muessig M, Dzagnidze A, Fritsche G, Diener HC, Limmroth V (2005) Medication overuse headache: rates and predictors for relapse in a 4-year prospective study. Cephalalgia 25:12–15CrossRefPubMedGoogle Scholar
  16. 16.
    Boe MG, Salvesen R, Mygland A (2009) Chronic daily headache with medication overuse: a randomized follow-up by neurologist or PCP. Cephalalgia 29:855–863CrossRefPubMedGoogle Scholar
  17. 17.
    Kristoffersen ES, Straand J, Vetvik KG, Benth JS, Russell MB, Lundqvist C (2014) Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial. J Neurol Neurosurg Psychiatry 86:5050–5512Google Scholar
  18. 18.
    Kristoffersen ES, Straand J, Benth JS, Russell MB, Lundqvist C (2012) Study protocol: brief intervention for medication overuse headache—a double-blinded cluster randomised parallel controlled trial in primary care. BMC Neurol 12:70CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Kristoffersen ES, Straand J, Russell MB, Lundqvist C (2014) Feasibility of a brief intervention for medication-overuse headache in primary care—a pilot study. BMC Res Notes 7:165CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Headache Classification Committee of the International Headache Society (2004) The International Classification of Headache Disorders: 2nd edition. Cephalalgia 24(Suppl 1):9–160Google Scholar
  21. 21.
    Silberstein SD, Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, Gobel H, Lainez MJ, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J, Steiner TJ (2005) The International Classification of Headache Disorders, 2nd Edition (ICHD-II)—revision of criteria for 8.2 Medication-overuse headache. Cephalalgia 25:460–465CrossRefPubMedGoogle Scholar
  22. 22.
    Grande RB, Aaseth K, Benth JS, Gulbrandsen P, Russell MB, Lundqvist C (2009) The Severity of Dependence Scale detects people with medication overuse: the Akershus study of chronic headache. J Neurol Neurosurg Psychiatry 80:784–789CrossRefPubMedGoogle Scholar
  23. 23.
    Gossop M, Darke S, Griffiths P, Hando J, Powis B, Hall W, Strang J (1995) The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction 90:607–614CrossRefPubMedGoogle Scholar
  24. 24.
    Stewart WF, Lipton RB, Whyte J, Dowson A, Kolodner K, Liberman JN, Sawyer J (1999) An international study to assess reliability of the Migraine Disability Assessment (MIDAS) score. Neurology 53:988–994CrossRefPubMedGoogle Scholar
  25. 25.
    Kosinski M, Bayliss MS, Bjorner JB, Ware JE Jr, Garber WH, Batenhorst A, Cady R, Dahlof CG, Dowson A, Tepper S (2003) A six-item short-form survey for measuring headache impact: the HIT-6. Qual Life Res 12:963–974CrossRefPubMedGoogle Scholar
  26. 26.
    Campbell MK, Piaggio G, Elbourne DR, Altman DG (2012) Consort 2010 statement: extension to cluster randomised trials. BMJ 345:e5661CrossRefPubMedGoogle Scholar
  27. 27.
    Schulz KF, Altman DG, Moher D (2010) CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMJ 340:332CrossRefGoogle Scholar
  28. 28.
    Bendtsen L, Bigal ME, Cerbo R, Diener HC, Holroyd K, Lampl C, Mitsikostas DD, Steiner TJ, Tfelt-Hansen P, International Headache Society Clinical Trials Subcommittee (2010) Guidelines for controlled trials of drugs in tension-type headache: second edition. Cephalalgia 30:1–16CrossRefPubMedGoogle Scholar
  29. 29.
    Silberstein S, Tfelt-Hansen P, Dodick DW, Limmroth V, Lipton RB, Pascual J, Wang SJ, Task Force of the International Headache Society Clinical Trials Subcommittee (2008) Guidelines for controlled trials of prophylactic treatment of chronic migraine in adults. Cephalalgia 28:484–495CrossRefPubMedGoogle Scholar
  30. 30.
    Hagen K, Jensen R, Boe MG, Stovner LJ (2010) Medication overuse headache: a critical review of end points in recent follow-up studies. J Headache Pain 11:373–377CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
  32. 32.
    Headache Classification Committee of the International Headache Society (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33:629–808CrossRefGoogle Scholar
  33. 33.
    Tassorelli C, Jensen R, Allena M, De Icco R, Sances G, Katsarava Z, Lainez M, Leston J, Fadic R, Spadafora S, Pagani M, Nappi G (2014) A consensus protocol for the management of medication-overuse headache: evaluation in a multicentric, multinational study. Cephalalgia 34:645–655CrossRefPubMedGoogle Scholar
  34. 34.
    Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B (2007) Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev 2:CD004148Google Scholar
  35. 35.
    Diener HC, Schorn CF, Bingel U, Dodick DW (2008) The importance of placebo in headache research. Cephalalgia 28:1003–1011CrossRefPubMedGoogle Scholar
  36. 36.
    Dodick DW, Turkel CC, DeGryse RE, Aurora SK, Silberstein SD, Lipton RB, Diener HC, Brin MF, Preempt Chronic Migraine Study Group (2010) OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache 50(6):921–936CrossRefPubMedGoogle Scholar
  37. 37.
    Munksgaard SB, Bendtsen L, Jensen RH (2012) Treatment-resistant medication overuse headache can be cured. Headache 52:1120–1129CrossRefPubMedGoogle Scholar
  38. 38.
    Munksgaard SB, Bendtsen L, Jensen RH (2013) Modulation of central sensitisation by detoxification in MOH: results of a 12-months detoxification study. Cephalalgia 33:444–453CrossRefPubMedGoogle Scholar
  39. 39.
    Wiles CM, Lindsay M (1996) General practice referrals to a department of neurology. J R Coll Physicians Lond 30:426–431PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Espen Saxhaug Kristoffersen
    • 1
    • 2
    Email author
  • Jørund Straand
    • 1
  • Kjersti Grøtta Vetvik
    • 3
    • 4
  • Jūratė Šaltytė Benth
    • 2
    • 4
  • Michael Bjørn Russell
    • 3
    • 4
  • Christofer Lundqvist
    • 2
    • 4
    • 5
  1. 1.Department of General Practice, Institute of Health and SocietyUniversity of OsloOsloNorway
  2. 2.HØKH, Research CentreAkershus University HospitalLørenskogNorway
  3. 3.Head and Neck Research Group, Research CentreAkershus University HospitalLørenskogNorway
  4. 4.Institute of Clinical Medicine, Campus Akershus University HospitalUniversity of OsloNordbyhagenNorway
  5. 5.Department of NeurologyAkershus University HospitalNordbyhagenNorway

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