Abstract
This study investigated the outcome of a 5-day headache-specific multidisciplinary treatment program (MTP) and the adherence to treatment recommendations in 295 prospectively recruited consecutive headache patients [210 migraine, 17 tension-type headache (TTH), 68 combination headache, including 56 medication-overuse headache (MOH)]. Headache frequency decreased from 13.4 (±8.8) to 8.8 (±8.0) days per month after 12–18 months. Forty-three percent of the participants fulfilled the primary outcome (reduction of headache frequency of ≥50%), which was less likely in patients with combination of migraine and TTH compared to migraine (OR = 3.136, p = 0.002) or TTH (OR = 1.029, n.s.). Increasing number of headache days per month (OR = 1.092, p ≤ 0.0001) and adherence to lifestyle modifications (OR = 1.269, p = 0.004) predicted primary outcome. 51 of 56 MOH patients were treated successfully. Thirty-five percent of the patients were adherent to pharmacological prophylaxis, 61% to relaxation therapy, and 72% to aerobic endurance sports. MTP is effective in headache treatment. Adherence to therapy was associated with better outcome.
Highlights
Primary headaches, in particular migraine and tensiontype headache (TTH) cause severe burden of disease and create high costs in the health care system [1, 2]
This study investigated the outcome of a 5-day headache-specific multidisciplinary treatment program (MTP) and the adherence to treatment recommendations in 295 prospectively recruited consecutive headache patients [210 migraine, 17 tension-type headache (TTH), 68 combination headache, including 56 medication-overuse headache (MOH)]
Thirty-eight patients were lost to follow-up, and 29 were excluded due to unwillingness to participate (n = 2), headache diagnoses other than migraine, TTH or MOH (n = 10), age under 16 years (n = 8), lacking knowledge of German language (n = 6) and early termination of the MTP (n = 3)
Summary
In particular migraine and tensiontype headache (TTH) cause severe burden of disease and create high costs in the health care system [1, 2]. Longitudinal studies in academic headache clinics reported relapse rates from 30 to 41% 1 year after initial outpatient withdrawal treatment in MOH [5,6,7,8]. TTH, and MOH is challenging for general practitioners and neurologists in private practice. Education about acute and prophylactic treatment is needed and may improve adherence to pharmacological as well as to non-pharmacological therapy. Compliance refers to the degree to which patients are obedient to medical treatment recommendations more generally [11]. Noncompliance and non-adherence are well-known problems of therapy and potentially result in treatment failure. Little is known about adherence to prophylactic headache treatment. A recent study reports nonadherence to medical prophylaxis in headache therapy in up to
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