In the United States, outpatients with chronic migraine (CM) with excessive headache (MOH) experience frequent headaches and very often undergo acute treatment, severe headache and migraine-related effects on daily function. significant pain disorders and high rates of depression and anxiety symptoms. This emerged from cross-sectional observations from the study on the drug overuse management strategy published in Headache.
A total of 610 patients (mean age 45 years) with CM and MOH were enrolled in the study from 34 health clinics in the United States. These clinics included specialty headache clinics, general neurology clinics, and primary care clinics.
Questionnaires were used to collect information on headache characteristics, medication use, and disability (Headache Impact Test 6) [HIT-6] and questionnaires on the functional impact of migraines [MFIQ]), Pain Interference (PROMIS Pain Interference), and Quality of Life (EQ-5D-5L) using questionnaire ratings. The researchers examined the relationships between this information and the frequency of headaches.
The majority of the study population (87.3%) was female. Overall, the average self-reported number of headache days per 30 days was 24.3, including 13.6 days with moderate to severe headache. Approximately 36.1% of the patients reported daily headaches.
On average, the mean number of acute headache medications used per 30 days was 21.5. Drugs often overused by patients included simple analgesics (62%), combination analgesics (41%), and triptans (21%).
The mean for HIT-6 was 65.0, suggesting that the headache in these patients had a serious impact on patient function. High levels of MFIQ, PROMIS Pain Interference, and EQ-5D-5L indicated that headaches and migraines in these patients severely affected their physical function and quality of life. The entire patient population also showed “mild” symptoms of anxiety and depression according to the mean GAD-7 value (Generalized Anxiety Disorder-7) of 7.9 and the mean PHQ-9 value (Patient Health Questionnaire-9) of 8.9 .
A higher headache frequency was significantly associated with moderate to severe headache days (P <0.001), more frequent use of acute headache medication (P <0.001), and greater headache-related disability (MFIQ usual activities worldwide) [P =.004]) and lower quality of life (EQ-5D-5L Health Today [P =.012]). Approximately 44.9% of the patients received preventive migraine therapy.
One limitation of this study was the recruitment of patients by doctors in an outpatient setting, which may limit the generalizability of the results in all patients with CM and MOH.
The researchers concluded that they hope that “appropriate treatment of these highly stressed patients will lead to improved physical and psychological well-being”.
Disclosure: Several authors of the study have stated that they are part of the pharmaceutical industry. For a full list of the authors’ information, see the original reference.
Schwedt TJ, Hentz JG, Sahai-Srivastava S. et al .; MOTS investigator. Headache characteristics and chronic migraine headache burden with overuse of medication: cross-sectional observations from the study of treatment strategy for overuse of medication. Published online 12 January 2021. Headache. doi: 10.1111 / head.14056
This article originally appeared on Clinical Pain Advisor