Self-Detoxification From Overuse of Headache Medications Reduces Disability
Withdrawal from overused medication may lead to reduced headache frequency and disability.
According to a study published in the European Journal of Neurology, self-detoxification performed by individuals with medication-overuse headache reduced headache-related disabilities. In addition, certain factors (headache frequency, co-occurrence of migraine, type of medication) determined a patient's resistance to treatment, predicting their ability to detoxify.
Researchers in this prospective cohort study drew the cohort from the general population of Akershus County, Norway, and included 108 individuals who were diagnosed with chronic headache by the International Classification of Headache Disorders. According to the Migraine Disability Assessment Score (MIDAS), the majority of the study population was considered severely disabled from medication overuse. All patients filled out a self-administered questionnaire and participated in a baseline interview and follow-up interviews approximately 1.5 years later. The study also identified various demographic and clinical characteristics that could potentially be used to predict the success of self-detoxification in the study population. These included gender, age, type of headache, headache frequency, migraine co-occurrence, type of overused medication, disability, and psychological distress.
Results of the study saw 44 individuals cured of medication-overuse headache, and 38 individuals achieved detoxification but still experienced chronic headache. One person continued to overuse medication but had no chronic headache, and 25 people still suffered medication-overuse headache. At follow-up, co-occurrence of migraine predicted successful self-detoxification, as did a lower headache frequency; high headache frequency pointed to higher treatment resistance. The use of analgesics was also a predictor for successful detoxification outcomes, whereas other painkillers present a more complex pathway for medication withdrawal. Disability and psychological factors were not significant predictors for outcomes success, yet self-detoxification reduced disability at follow-up.
One limitation of the study was that it did not include a control group; however, remission without self-detoxification is highly unlikely. Another possible limitation of the study was presenting subjects with non-systematic and unstructured information regarding medication overuse and chronic headache.
Previous studies suggest that individuals who overuse headache medication and consequently develop chronic headaches are more disabled than those who experience chronic headaches without medication overuse. The authors of this study highlight the specific clinical value of detoxification in improving disability outcomes in people with medication-overuse headache, along with the factors used to predict a person's ability to self-detoxify.
Kristoffersen ES, Grande RB, Aaseth K, Russell MB, Lundqvist C. Medication-overuse headache detoxification reduces headache disability – the Akershus study of chronic headache [published online May 10, 2018]. Eur J Neurol. doi: 10.1111/eve.13674