Predictors of Successful Detox in Medication Overuse Headache

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BRIEF COMMUNICATION

A Norwegian study has found that about 75% of people with medication overuse headache can self-detoxify when given educational information about it, which may result in fewer headaches 1.5 years later.¹ Results also showed that predictors of successful self-detox included episodic migraine, fewer headache days at baseline, and use of simple analgesics.

“Detoxification should be offered to medication overuse headache patients as early as possible with a focus on headache frequency, disability and psychological distress,” wrote first author Espen Saxhaug Kristoffersen MD,PhD, of Akershus University hospital, Lørenskog, Norway.

Medication overuse headache, or a chronic headache that lasts over 15 days per month and is associated with excess use of headache medication, can cause significant disability. Some studies have suggested that patients with medication overuse headache may be among the most disabled of headache patients.

In a previous study that included about 30,000 Norwegian adults, this group of researchers found that providing simple, unstructured information about medication overuse helped about 76% of patients self-detox. Forty-two percent of them were free of chronic headache 1.5 years later.² However, that study did not assess predictors of successful detox.

To further evaluate the issue, researchers conducted a prospective cohort study. Participants were initially screened using a mailed questionnaire. Among 925 respondents, 68% (n = 633) reported chronic headache and had a face-to-face interview at Askershus University Hospital, Norway. Those with medication overuse headache received unstructured, oral information about the role of medication in their headaches. Follow-up occurred mainly by telephone a year and a half later, with a participation rate of 84%. Researchers scored headache severity using the standardized Migraine Disability Assessment (MIDAS).

About 54% of those with medication overuse headache reported severe disability at baseline, and about 75% successfully self-detoxed. Those who successfully self-detoxed and reverted to episodic headache had significant reduction in MIDAS score, compared to those with continued medication overuse (17.3 vs 44.9, respectively, p < 0.01).

Key results:

• Predictors of successful detox:

• Episodic migraine (p=0.044)
• Lower headache frequency at baseline (p=0.01)
• Overuse of simple analgesics vs other painkillers (p=0.024)

• Predictors of high headache frequency at follow-up:

• High baseline headache frequency (p=0.023)
• High psychological distress (p=0.002)

The authors mentioned that many participants overused simple analgesics, which was a significant predictor of successful detox at follow-up. Use of other painkillers like central-acting agents may indicate more complex or treatment-resistant headaches. Likewise, more frequent headache days at baseline could indicate treatment-resistant headaches.

“In the present study, a higher headache frequency at baseline predicted failure to self-detoxify. This subgroup of medication overuse headache sufferers should probably receive increased focus and possibly more targeted interventions and follow-up,” they concluded. The study was conducted in a single county in southeast Norway, and results may not necessarily generalize more broadly.

Take home points

• Norwegian study found 75% of medication overuse headache sufferers can successfully self-detox, which may decrease headache severity 1.5 years later

• Predictors of successful detox include episodic migraine, lower headache frequency at baseline, overuse of simple analgesics

• Predictors of high headache frequency at follow-up include high headache frequency and high psychological distress at baseline

References:

1. Kristoffersen ES, Grande RB, Aaseth K, et al. Medication-overuse headache detoxification reduces headache disability - The Akershus study of chronic headache. Eur J Neurol. May 2018. [epub ahead of print]

2. Grande RB, Aaseth K, Benth JÅ , et al. Reduction in medication-overuse headache after short information. The Akershus study of chronic headache. Eur J Neurol. 2011;18:129-137.