Brief intervention by general practitioners for medication-overuse headache, follow-up after 6 months: a pragmatic cluster-randomised controlled trial
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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.
KeywordsMedication-overuse headache Migraine Screening and brief intervention General practice Severity of dependence scale Cluster-randomised trial
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
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.
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