Abstract
BackgroundMedication overuse headache (MOH) has been recognized as an important problem in headache patients although the pathophysiological mechanisms remain unclear. The diagnosis of MOH is based on clinical characteristics defined by the International Headache Society. The aim was the evaluation of the diagnostic criteria of MOH in a mixed population of chronic pain patients to gain information about the prevalence and possible associations with MOH.MethodsData of all patients referred to the interdisciplinary pain clinic at the University Hospital of Zurich between September 2005 and December 2007 were retrospectively analyzed. Demographic data (age, sex, history of migration), as well as data about duration of pain disease, category of pain disease (neurological, psychiatric, rheumatologic, other), use of medication, history of trauma, and comorbidity of depression and anxiety have been collected.ResultsTotally 178 of 187 consecutive chronic pain patients were included in the study. A total of 138 patients (78%) used analgesics on 15 or more days per month. Chronic headache was more prevalent among patients with analgesic overuse (39.8%) than without analgesic overuse (18%). The prevalence of MOH was 29%. The odds ratio (OR) for a patient with medication overuse to have chronic headache was 13.1 if he had a history of primary headache, compared to a patient without a primary headache syndrome. Furthermore, history of headache (OR 2.5, CI [1.13;5.44]), history of migration (OR 2.9, CI [1.31;6.32]) and comorbid depression (OR 3.5, CI [1.46;8.52]) were associated with overuse of acute medication, in general.ConclusionsPrimary headaches have a high risk for chronification in patients overusing analgesics for other pain disorders. Whereas history of headache, history of migration and comorbidity of depression are independentely associated with analgesic overuse in this group of patients.
Highlights
Medication overuse headache (MOH) has been recognized as an important problem in headache patients the pathophysiological mechanisms remain unclear
Another population from a rheumatolgy clinic was studied by Williams et al, finding that 14 of 114 (12%) patients suffered from chronic daily headache, whereas 9 (8%) patients met the criteria for problable MOH according to ICHD-II revised criteria [28,30]
In summary, our study showed that MOH might be more prevalent in chronic pain patients than previously suggested
Summary
Medication overuse headache (MOH) has been recognized as an important problem in headache patients the pathophysiological mechanisms remain unclear. Population-based studies have identified possible risk factors for the development of chronic headache, such as age, female gender, low socioeconomic status, non-married civil status, obesity, snoring, comorbid musculosceletal pain, head and neck injury, and stressful life events [21,22]. This has raised the question whether chronic headache is the consequence or the cause of overused analgesics [21,23]. Previous studies, using other than the ICHD-II-Appendix criteria for the definition of MOH, showed conflicting results regarding new onset headache under medication overuse [24,25,26,27,28]
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