HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.
BMC Neurol. 2012 Aug 10;12:70. doi: 10.1186/1471-2377-12-70.
Chronic 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/DESIGN: A 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.
There 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.
慢性头痛（每月头痛≥15 天，至少持续 3 个月）影响了 2-5%的普通人群。药物滥用是导致该问题的原因之一。药物过度使用性头痛（MOH）可以通过使用严重依赖量表（SDS）进行识别。在其他环境中，曾经使用过“简短干预”方案（BI）来戒除药物和酒精滥用。简短、非结构化、个性化的简单信息也可能足以使大部分 MOH 患者戒除药物。我们已经改编了结构化（BI）方案，以便在初级保健中用于 MOH。
方法/设计：BI 与常规治疗相比的双盲集群随机平行对照试验（RCT）。干预措施将由接受 BI 培训的全科医生在初级保健中进行。通过向全科医生名单上的患者发送简单的筛查问卷来识别 MOH 患者。BI 方法涉及使用关于头痛频率和 SDS 评分的简单问题，来确定患有高可能性 MOH 的患者。向个体患者提供关于其得分的反馈以及这可能对其药物过度使用导致头痛的个体风险产生的影响。最后，提供有关应采取的措施、患者应如何进行以及患者可能获得的收益的建议。参与患者在干预后三个月完成头痛日记，并由经验丰富的头痛诊断全科医生进行临床访谈和神经系统检查。主要结果是 3 个月时头痛天数和每月用药天数。次要结果包括 3 个月时改善 25%和 50%的比例以及 12 个月后改善和生活质量的维持。
需要有循证和具有成本效益的 MOH 治疗策略，但到目前为止，还没有就最佳药物戒断方法达成共识。据我们所知，这是在初级保健中进行的结构化非药物性 MOH 治疗的首个 RCT。结果可能有潜力为全科医生治疗普通人群中的 MOH 患者提供一种手段。
