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

the Comoestas Consortium

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalCephalalgia
DOIs
Publication statusAccepted/In press - Jan 1 2018

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Secondary Headache Disorders
Odds Ratio
Psychology
Headache
Tension-Type Headache
Headache Disorders
Population
Migraine Disorders
Quality of Life
Flunarizine
Therapeutics
Latin America
Psychiatry
Comorbidity
Multivariate Analysis
Recurrence

Keywords

  • anxiety
  • depression
  • disability
  • quality of life
  • relapse
  • Withdrawal

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

@article{bc1995723de540e290e1316a41681f9c,
title = "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",
abstract = "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.",
keywords = "anxiety, depression, disability, quality of life, relapse, Withdrawal",
author = "{the Comoestas Consortium} and Sara Bottiroli and Marta Allena and Grazia Sances and {De Icco}, Roberto and Micol Avenali and Ricardo Fadic and Zaza Katsarava and Lainez, {Miguel J.A.} and Goicochea, {Maria Teresa} and Lars Bendtsen and Jensen, {Rigmor H{\o}jland} and Giuseppe Nappi and Cristina Tassorelli",
year = "2018",
month = "1",
day = "1",
doi = "10.1177/0333102418783317",
language = "English",
journal = "Cephalalgia",
issn = "0333-1024",
publisher = "SAGE Publications Ltd",

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T1 - Psychological, clinical, and therapeutic predictors of the outcome of detoxification in a large clinical population of medication-overuse headache

T2 - A six-month follow-up of the COMOESTAS Project

AU - the Comoestas Consortium

AU - Bottiroli, Sara

AU - Allena, Marta

AU - Sances, Grazia

AU - De Icco, Roberto

AU - Avenali, Micol

AU - Fadic, Ricardo

AU - Katsarava, Zaza

AU - Lainez, Miguel J.A.

AU - Goicochea, Maria Teresa

AU - Bendtsen, Lars

AU - Jensen, Rigmor Højland

AU - Nappi, Giuseppe

AU - Tassorelli, Cristina

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - anxiety

KW - depression

KW - disability

KW - quality of life

KW - relapse

KW - Withdrawal

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SN - 0333-1024

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