In the United States, outpatients with chronic migraine (CM) with medication overuse headache (MOH) experience frequent headaches and have a very high-frequency intake of acute treatments, severe headache- and migraine-related impacts on day-to-day function, substantial pain interference, and high rates of depression and anxiety symptoms. This was according to cross-sectional observations from the Medication Overuse Treatment Strategy trial, published in Headache.

A total of 610 patients (mean age, 45 years) with CM and MOH were enrolled in the trial from 34 healthcare clinics across the United States. These clinics included headache specialty clinics, general neurology clinics, and primary care clinics.

Questionnaires were used to collect information on headache characteristics, medication use, disability (Headache Impact Test 6 [HIT-6] and Migraine Functional Impact Questionnaire [MFIQ]), pain interference (PROMIS Pain Interference), and quality of life (EQ-5D-5L) using questionnaire assessments. The investigators explored the relationships between this information and headache frequency.

Most of the study population (87.3%) was female. Overall, the mean self-reported number of headache days per 30 days was 24.3, which included 13.6 days spent with moderate to severe headache. Approximately 36.1% of patients reported daily headaches.


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On average, the mean number of acute headache medications used per 30 days was 21.5. Medications commonly overused by patients included simple analgesics (62%), combination analgesics (41%), and triptans (21%).

The mean score on HIT-6 was 65.0, which suggests that the headaches in these patients had a severe impact on patient functioning. High MFIQ, PROMIS Pain Interference, and EQ-5D-5L scores indicated that headache and migraine in these patients substantially affected their physical functioning and quality of life. The overall patient population also demonstrated “mild” anxiety and depression symptoms, according to the mean Generalized Anxiety Disorder-7 (GAD-7) score of 7.9 and mean Patient Health Questionnaire-9 (PHQ-9) score of 8.9, respectively.

A higher headache frequency was significantly associated with greater moderate-severe headache days (P <.001), more frequent acute headache medication use (P <.001), greater headache-related disability (MFIQ usual activities global [P =.004]), and lower quality of life (EQ-5D-5L health today [P =.012]). Approximately 44.9% of patients were taking a migraine preventive therapy.

A limitation of this study was the recruitment of patients by clinicians within an outpatient setting, which may limit the generalizability of the findings across all patients with CM and MOH.

The investigators concluded that they hope “appropriate treatment for these highly burdened patients will lead to improved physical and psychological well-being.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Schwedt TJ, Hentz JG, Sahai-Srivastava S, et al; MOTS Investigators. Headache characteristics and burden from chronic migraine with medication overuse headache: cross-sectional observations from the Medication Overuse Treatment Strategy trial. Published online January 12, 2021. Headache. doi:10.1111/head.14056