Psychological, clinical, and therapeutic predictors of the outcome of detoxification in a large clinical population of medication-overuse headache: A six-month follow-up of the COMOESTAS Project.

Autor: Bottiroli S; 1 Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy., Allena M; 1 Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy., Sances G; 1 Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy., De Icco R; 1 Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.; 2 Department of Brain and Behavioral Sciences, University of Pavia, Italy., Avenali M; 1 Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.; 2 Department of Brain and Behavioral Sciences, University of Pavia, Italy., Fadic R; 3 Department of Neurology, Pontificia Catolica University of Chile, Santiago, Chile., Katsarava Z; 4 Department of Neurology, University of Essen, Germany., Lainez MJ; 5 Foundation of the Valencian Community, University Clinical Hospital, Spain., Goicochea MT; 6 Integral Pain Centre, Fundación para la Lucha contra las Enfermedades Neurológicas Infantiles (FLENI), Buenos Aires, Argentina., Bendtsen L; 7 Danish Headache Centre, Department of Neurology, Glostrup Hospital, Glostrup, Denmark., Jensen RH; 7 Danish Headache Centre, Department of Neurology, Glostrup Hospital, Glostrup, Denmark., Nappi G; 1 Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy., Tassorelli C; 1 Headache Science Centre, IRCCS Mondino Foundation, Pavia, Italy.; 2 Department of Brain and Behavioral Sciences, University of Pavia, Italy.
Jazyk: angličtina
Zdroj: Cephalalgia : an international journal of headache [Cephalalgia] 2019 Jan; Vol. 39 (1), pp. 135-147. Date of Electronic Publication: 2018 Jun 27.
DOI: 10.1177/0333102418783317
Abstrakt: Aim: To identify factors that may be predictors of the outcome of a detoxification treatment in medication-overuse headache.
Methods: Consecutive patients entering a detoxification program in six centres in Europe and Latin America were evaluated and followed up for 6 months. We evaluated anxious and depressive symptomatology (though patients with severe psychiatric comorbidity were excluded), quality of life, headache-related disability, headache characteristics, and prophylaxis upon discharge.
Results: Of the 492 patients who completed the six-month follow up, 407 ceased overuse following the detoxification (non overusers), another 23 ceased overuse following detoxification but relapsed during the follow-up. In the 407 non-overusers, headache acquired an episodic pattern in 287 subjects (responders). At the multivariate analyses, lower depression scores (odds ratio = 0.891; p = 0.001) predicted ceasing overuse. The primary headache diagnosis - migraine with respect to tension-type headache (odds ratio = 0.224; p = 0.001) or migraine plus tension-type headache (odds ratio = 0.467; p = 0.002) - and the preventive treatment with flunarizine (compared to no such treatment) (odds ratio = 0.891; p = 0.001) predicted being a responder. A longer duration of chronic headache (odds ratio = 1.053; p = 0.032) predicted relapse into overuse. Quality of life and disability were not associated with any of the outcomes.
Conclusions: Though exploratory in nature, these findings point to specific factors that are associated with a positive outcome of medication-overuse headache management, while identifying others that may be associated with a negative outcome. Evaluation of the presence/absence of these factors may help to optimize the management of this challenging groups of chronic headache sufferers.
Databáze: MEDLINE
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