Kristoffersen E S, Straand J, Benth J Š, Russell M B, Lundqvist C
Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.
Acta Neurol Scand. 2017 Nov;136(5):486-494. doi: 10.1111/ane.12759. Epub 2017 Mar 28.
To investigate predictors for successful treatment outcome after a brief intervention (BI) for medication-overuse headache (MOH).
This study evaluated predictors of successful withdrawal among patients initially participating in a pragmatic cluster-randomized controlled trial with single crossover in Norwegian general practice (the BIMOH study). BI (early or after crossover) was compared to business as usual (BAU) for the treatment of MOH. Patients were followed up 3 months after the BI.
In total, 46 patients had the chance to receive the BI (24 early and 22 after crossover) and were included in the predictor analyses. The mean reduction in headache and medication days/month from baseline for the BI was 6.9 (95% CI: 4.8-9.1) and 10.9 (8.1-13.6). The mean percentage reduction in headache and medication days was 30.5% (21.4-39.7) and 50.4% (39.5-61.3). Only five patients started prophylactic medication. Neither age, gender, co-occurrence of migraine, main type of overused drug at baseline nor Severity of Dependence Scale score at baseline predicted successful withdrawal in the prespecified analyses. Headache days/month and medication use at baseline were significant predictors in exploratory analyses with more headache and medication days predicting worse outcome.
Brief intervention for MOH is a simple and effective intervention in primary care. As the only identified predictors were frequency of headache and medication use, we conclude that treatment for all MOH patients should be attempted in primary care before referral. A raised awareness of MOH is important, as the condition is highly preventable and treatable.
ClinicalTrials.gov identifier: NCT01314768.
探讨药物过量使用性头痛（MOH）简短干预（BI）后治疗成功结局的预测因素。
本研究评估了最初参与挪威全科医疗实用整群随机对照试验且单次交叉试验（BIMOH研究）的患者成功戒断的预测因素。将BI（早期或交叉后）与常规治疗（BAU）用于MOH治疗进行比较。在BI后3个月对患者进行随访。
共有46例患者有机会接受BI（24例早期接受，22例交叉后接受）并纳入预测因素分析。BI组从基线开始头痛天数和每月用药天数的平均减少量分别为6.9（95%CI：4.8 - 9.1）和10.9（8.1 - 13.6）。头痛天数和用药天数的平均减少百分比分别为30.5%（21.4 - 39.7）和50.4%（39.5 - 61.3）。仅有5例患者开始预防性用药。在预先设定的分析中，年龄、性别、偏头痛共病情况、基线时过度使用药物的主要类型以及基线时的药物依赖严重程度量表评分均未预测成功戒断。在探索性分析中，每月头痛天数和基线时的用药情况是显著的预测因素，头痛和用药天数越多，结局越差。
MOH的简短干预在初级保健中是一种简单有效的干预措施。由于唯一确定的预测因素是头痛频率和用药情况，我们得出结论，在转诊前应尝试在初级保健中对所有MOH患者进行治疗。提高对MOH的认识很重要，因为这种情况具有高度可预防性和可治疗性。
ClinicalTrials.gov标识符：NCT01314768。
