Identifying Medication-Overuse Headache

array of colorful pills
array of colorful pills
The identification of patients with medication-overuse headache may be facilitated by assessing factors such as headache-related disability, use of combination medications, and fear of pain.

Assessing factors such as headache-related disability, use of combination medications, and fear of pain may help identify patients with medication-overuse headache, according to a study published in Headache.

To determine factors that best predict medication-overuse headache, researchers surveyed a sample of US adults (mean age, 40 years) seeking treatment for primary headache disorder. In addition to a demographic questionnaire, participants provided data on their headache using the Structured Diagnostic Interview for Headache-3 online survey and the Structured Diagnostic Interview for Headache. Headache-related disability was assessed using the Headache Impact Test-6, and psychological variables were determined using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder 7-Item Scale, and the Pain Anxiety Symptoms Scale. The use of headache and other prescription medications and substances was also reviewed.

Researchers found that 43 of the study’s 164 participants (26.2%) met diagnostic criteria for medication-overuse headache. These individuals experienced more headache days per month on average than those without medication-overuse headache (20.58 vs 9.60; P =.001).

In addition, compared with participants not experiencing medication-overuse headache, those with medication-overuse headache reported greater headache-related disability (odds ratio [OR], 1.09; 95% CI, 1.01-1.18), attempts to escape and avoid stimuli associated with pain (OR, 1.07; 95% CI, 1.07-1.15), and use of combination medications for headache (OR, 3.10; 95% CI, 1.51-6.36).

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The researchers cited several limitations, including an inability to determine temporal ordering of variables, a lack of biologic markers, and a low survey response rate.

Based on these findings, researchers determined the above risk factors could accurately identify individuals with medication-overuse headache. “The present study is a first step in an effort to more effectively identify and ultimately treat [people with] headache who are overusing acute headache medications,” they concluded.

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Peck KR, Roland MM, Smitherman TA. Factors associated with medication-overuse headache in patients seeking treatment for primary headache [published online March 9, 2018]. Headache. doi: 10.1111/head.13294