Abstract
Background: MOH can be diagnosed in subjects with headache occurring 15 days/month in association with a regular medication overuse, but its existence is not universally accepted. ICHD-3 redefined criteria for MOH, removing the criterion associating drug suspension with headache course. The aim of our study was to compare the rate of patients diagnosed with medication overuse headache (MOH) according to ICHD-2 and ICHD-3 criteria, to verify the degree of concordance. The secondary aim was to verify if drug withdrawal was really associated with pain relief.Methods: In this cross-sectional study, we retrospectively analyzed a sample of 400 patients followed for primary chronic headache at the Headache Center of Bambino Gesù Children's Hospital. We then selected those presenting with a history of medication overuse, and we applied both ICHD-2 and ICHD-3 criteria to verify in which patients the criteria would identify a clinical diagnosis of MOH.Results: We identified 42 subjects (10.5%) with MOH; 23 of them (55%) presented a relief of headache withdrawing drug overuse. Regarding the applicability of the ICHD-2 criteria, 43% of patients (18/42) fulfilled all criteria, while all ICHD-3 diagnostic criteria were satisfied in 76% of patients (32/42). Eighteen patients (43%) satisfied both ICHD-2 and ICHD-3 criteria, while 10 patients (24%) did not satisfy either diagnostic criterion.Conclusions: Our study suggests that in children and adolescents, withdrawing medication overuse is not always associated with a clinical benefit. Therefore, though allowing a MOH diagnosis in a higher rate of patients as compared to ICHD-2, the application of ICHD-3 criteria does not guarantee a true a causal relationship between medication overuse and headache worsening.
Highlights
Medication overuse headache (MOH) is a headache occurring on 15 or more days/month in a patient with a preexisting primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication for more than 3 months [1]
This trial plans to evaluate whether the frequency of acute medication overuse is associated with headache frequency in children and adolescents, and the outcomes will be frequency of headache, change in headache frequency in relation to use of acute medications, and headache-related disability [17]
The aim of our study was to compare the rate of patients diagnosed with MOH according to the old ICHD-2 and new ICHD-3 criteria, in order to verify the degree of concordance and understand if the new classification really led to different diagnostic rates
Summary
Medication overuse headache (MOH) is a headache occurring on 15 or more days/month in a patient with a preexisting primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more or 15 or more days/month, depending on the medication) for more than 3 months [1]. Data from pediatric populations with chronic primary headache disorders report a medication overuse in 10–60% of cases [14]. Both in adults and in children, MOH appears to be more common among females than among males [15, 16]. A planned study will clarify some aspect of pediatric MOH [17] This trial plans to evaluate whether the frequency of acute medication overuse is associated with headache frequency in children and adolescents, and the outcomes will be frequency of headache, change in headache frequency in relation to use of acute medications, and headache-related disability [17]. The secondary aim was to verify if drug withdrawal was really associated with pain relief
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