Study protocol: Brief intervention for medication overuse headache - A double-blinded cluster randomised parallel controlled trial in primary care

Christofer Lundqvist,Jūratė Saltytė Benth,Espen Saxhaug Kristoffersen,Jørund Straand,Michael Bjørn Russell

doi:10.1186/1471-2377-12-70

Christofer Lundqvist, Jūratė Saltytė Benth + Show 3 more

Open Access

https://doi.org/10.1186/1471-2377-12-70

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Journal: BMC Neurology	Publication Date: Aug 10, 2012
Citations: 109	License type: cc-by

Affiliation: Akershus University Hospital, University of Oslo

Abstract

BackgroundChronic headache (headache ≥ 15 days/month for at least 3 months) affects 2–5% of the general population. Medication overuse contributes to the problem. Medication-overuse headache (MOH) can be identified by using the Severity of Dependence Scale (SDS). A “brief intervention” scheme (BI) has previously been used for detoxification from drug and alcohol overuse in other settings. Short, unstructured, individualised simple information may also be enough to detoxify a large portion of those with MOH. We have adapted the structured (BI) scheme to be used for MOH in primary care.Methods/DesignA double-blinded cluster randomised parallel controlled trial (RCT) of BI vs. business as usual. Intervention will be performed in primary care by GPs trained in BI. Patients with MOH will be identified through a simple screening questionnaire sent to patients on the GPs lists. The BI method involves an approach for identifying patients with high likelihood of MOH using simple questions about headache frequency and the SDS score. Feedback is given to the individual patient on his/her score and consequences this might have regarding the individual risk of medication overuse contributing to their headache. Finally, advice is given regarding measures to be taken, how the patient should proceed and the possible gains for the patient. The participating patients complete a headache diary and receive a clinical interview and neurological examination by a GP experienced in headache diagnostics three months after the intervention. Primary outcomes are number of headache days and number of medication days per month at 3 months. Secondary outcomes include proportions with 25 and 50% improvement at 3 months and maintenance of improvement and quality of life after 12 months.DiscussionThere is a need for evidence-based and cost-effective strategies for treatment of MOH but so far no consensus has been reached regarding an optimal medication withdrawal method. To our knowledge this is the first RCT of structured non-pharmacological MOH treatment in primary care. Results may hold the potential of offering an instrument for treating MOH patients in the general population by GPs.Trial registrationClinicalTrials.gov identifier: NCT01314768

Highlights

IntroductionChronic headache (headache ≥ 15 days/month for at least 3 months) affects 2–5% of the general population
Chronic headache affects 2–5% of the general population
Results may hold the potential of offering an instrument for treating Medication-overuse headache (MOH) patients in the general population by general practitioners (GPs)

Summary

Introduction

Chronic headache (headache ≥ 15 days/month for at least 3 months) affects 2–5% of the general population. Medication-overuse headache (MOH) can be identified by using the Severity of Dependence Scale (SDS). 2–5% of the world’s population have chronic headache [4,5,6,7,8,9,10,11,12,13] defined as 15 or more headache days per month for at least 3 months and/or 180 or more headache days per year. Headache accounts for 4% of the general practitioners (GPs) consultations [19], and is probably the most common reason for referral to neurologists [19,20]. 20–30% of all new referrals to out-patients neurological departments are due to headache [21,22]

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