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Rigshospitalet - en del af Københavns Universitetshospital
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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

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  • Sara Bottiroli
  • Marta Allena
  • Grazia Sances
  • Roberto De Icco
  • Micol Avenali
  • Ricardo Fadic
  • Zaza Katsarava
  • Miguel Ja Lainez
  • Maria Teresa Goicochea
  • Lars Bendtsen
  • Rigmor Højland Jensen
  • Giuseppe Nappi
  • Cristina Tassorelli
  • Comoestas Consortium
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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.

OriginalsprogEngelsk
TidsskriftCephalalgia : an international journal of headache
Vol/bind39
Udgave nummer1
Sider (fra-til)135-147
Antal sider13
ISSN0333-1024
DOI
StatusUdgivet - 2019

ID: 58955027