Predictors of 12-Months Relapse After Withdrawal Treatment in Hospitalized Patients With Chronic Migraine Associated With Medication Overuse: A Longitudinal Observational Study

Alberto Raggi, Ambra M. Giovannetti, Matilde Leonardi, Emanuela Sansone, Silvia Schiavolin, Marcella Curone, Licia Grazzi, Susanna Usai, Domenico D'Amico

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Studies addressing relapse rates conflate relapse into chronic migraine (CM) and medication overuse (MO), and the consequent need to repeat withdrawal. We aim to identify 12-months predictors of relapse into CM (based on headaches frequency) separately from occurrence of another structured withdrawal. Methods: Hospitalized patients with CM-MO under withdrawal were enrolled. Candidate predictors included demographic, disability, quality of life, depression scores, general self-efficacy, social support, headaches frequency and intensity, class of overused medications, history of withdrawal treatment in the three years prior to enrollment, attendance to emergency room (ER) between enrollment and follow-up, nonattendance to outpatient neurological examinations. Logistic regressions was used to address the significant predictors for the two outcomes. Results: Complete data were available for 177 patients: 60 (33.9%) relapsed into CM, 38 (21.5%) underwent another withdrawal treatment. Recent history of withdrawal treatments, ER admission after discharge and high baseline BDI-II scores were significant predictors in both models. In addition to this, high baseline headache frequency predicted relapse into another withdrawal treatment. Conclusions: Predictors or relapse into CM and of occurrence of another withdrawal by 12-months are somehow similar. It is important to assess presence of recent previous withdrawal treatments and to plan regular follow-up afterwards, in particular for patients with high headache frequency and relevant mood disturbances: in this way, it will be more likely that situations requiring further structured withdrawal treatments can be identified before patients have to refer to ER.

Original languageEnglish
Pages (from-to)60-70
Number of pages11
JournalHeadache
Volume57
Issue number1
DOIs
Publication statusPublished - Jan 1 2017

Keywords

  • chronic migraine
  • depression
  • emergency room
  • medication overuse
  • relapse rate
  • withdrawal treatment

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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