Psychological, clinical, and therapeutic predictors of the outcome of detoxification in a large clinical population of medication-overuse headache : a six-month follow-up of the COMOESTAS Project

ORCID
0000-0002-0151-3962
Affiliation
Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
Bottiroli, Sara;
Affiliation
Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
Allena, Marta;
ORCID
0000-0001-8257-2886
Affiliation
Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
Sances, Grazia;
ORCID
0000-0001-9415-4948
Affiliation
Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
De Icco, Roberto;
ORCID
0000-0002-7880-9921
Affiliation
Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
Avenali, Micol;
ORCID
0000-0001-7050-5133
Affiliation
Department of Neurology, Pontificia Catolica University of Chile, Santiago, Chile
Fadic, Ricardo;
GND
1209715945
ORCID
0000-0002-9932-1159
LSF
12952
Affiliation
Department of Neurology, University of Essen, Germany
Katsarava, Zaza;
ORCID
0000-0002-6460-7106
Affiliation
Foundation of the Valencian Community, University Clinical Hospital, Spain
Lainez, Miguel J. A.;
Affiliation
Integral Pain Centre, Fundación para la Lucha contra las Enfermedades Neurológicas Infantiles (FLENI), Buenos Aires, Argentina
Goicoechea, Maria Teresa;
ORCID
0000-0002-4810-4998
Affiliation
Danish Headache Centre, Department of Neurology, Glostrup Hospital, Glostrup, Denmark
Bendtsen, Lars;
Affiliation
Danish Headache Centre, Department of Neurology, Glostrup Hospital, Glostrup, Denmark
Jensen, Rigmor Højland;
GND
1041790619
ORCID
0000-0003-4274-5281
Affiliation
Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
Nappi, Giuseppe;
ORCID
0000-0003-1513-2113
Affiliation
Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy
Tassorelli, Cristina;
Affiliation
COMOESTAS Consortium: Giorgio Sandrini (C. Mondino National Neurological Institute, and Department of Brain and Behavioural Sciences, University of Pavia, Director of Coordinating Centre); Signe B Munksgaard (Danish Headache Centre, Site Investigator); Marina Rapsch (Department of Neurology, University of Essen, Site Investigator); Beatriz Lopez (Foundation of the Valencian Community, Site Investigator); Daniel Cerquetti (Foundation for Combatting Neurological Diseases of Childhood, Site Technological Manager); Beatriz Shand (Department of Neurology, Pontificia Catolica University of Chile, Site sub-investigator); Maria Osa (ISalud University, Public Health Expert); Andrea Stoppini (Bioengeneering and Medical Informatics Consortium, Technological Manager).
the COMOESTAS Consortium

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.

Cite

Citation style:
Could not load citation form.

Rights

License Holder:

© International Headache Society 2018

Use and reproduction:
All rights reserved

Export