Chronic daily headache with medication overuse: predictors of outcome 1 year after withdrawal therapy

• Published in: European journal of neurology Vol. 16; no. 6; pp. 705 - 712
• Main Authors: Bøe, M. G., Salvesen, R., Mygland, Å.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.06.2009
• Subjects: Adult; Analgesics - adverse effects; Analgesics, Opioid - adverse effects; Causality; Codeine - adverse effects; Female; Follow-Up Studies; Headache Disorders - chemically induced; Headache Disorders - therapy; Headache Disorders, Secondary - therapy; Humans; Male; medication overuse headache; Middle Aged; Norway; Pain Measurement; Patient Selection; Predictive Value of Tests; Prognosis; Prospective Studies; quality of life; Self-Assessment; sleep; Sleep Wake Disorders - complications; Substance Withdrawal Syndrome; Time; Treatment Outcome; withdrawal; Norway
• ISSN: 1351-5101; 1468-1331; 1471-0552
• DOI: 10.1111/j.1468-1331.2009.02571.x

Background and purpose:  We examined prospectively the results of withdrawal therapy in 80 patients with probable medication overuse headache. The aim was to identify baseline patient characteristics that might predict outcome after 1 year (end of study). Methods:  We classified patients according to results of withdrawal therapy measured as the improvement of headache days (HD) from baseline to end of study. Results:  Thirty‐six per cent (29/80) had at least 50% improvement. Sixty‐four per cent (51/80) had <50% improvement, and among these, 30% (24/80) had <10% improvement. The following baseline characteristics were associated with poor outcome of withdrawal therapy: use of codeine‐containing drugs, low self‐reported sleep quality, and high self‐reported bodily pain as measured by the quality of life tool SF‐36. Conclusion:  Before suggesting withdrawal therapy, one should probably pay more close attention to sleep problems.