Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.
Eur J Neurol. 2017 Jul;24(7):883-891. doi: 10.1111/ene.13318. Epub 2017 May 23.
Withdrawal therapy improves the headache situation for many patients with medication-overuse headache (MOH), but relapses are common. The objective was to assess the long-term effectiveness of a general practitioner conducted brief intervention (BI) for MOH.
Sixty MOH patients initially participating in a blinded cluster-randomized controlled trial evaluating BI versus business as usual (BAU) were followed up for 16 months. Follow-up was open after 6 months. Headache and medication days per month were evaluated in three groups: BI early (BI throughout the study, n = 24), BI late (initial BAU, then cross-over to BI, n = 22) and BAU throughout the study (n = 14).
Fifty-five of 60 initially included patients completed the follow-up. The mean change over 16 months' observation in the BI early group was a reduction of 8.4 (5.4-11.4) headache and 13.5 (9.6-17.3) medication days per month. The relapse rate into medication overuse was 8.3%. Patients in the BI late group also improved significantly after a BI. BAU showed no significant improvement.
Treatment for MOH in primary care through a BI is a simple intervention with lasting effects and low relapse rate. This approach may be a logical first step in MOH treatment, and referral should generally be reserved for primary care non-responders.
戒断疗法可改善许多药物过度使用性头痛（MOH）患者的头痛状况，但复发较为常见。本研究旨在评估初级保健医生实施的简短干预（BI）治疗 MOH 的长期疗效。
最初参与评估 BI 与常规治疗（BAU）的双盲聚类随机对照试验的 60 例 MOH 患者，随访 16 个月。6 个月后，随访转为开放。在 3 组中评估头痛和每月用药天数：BI 早期（BI 贯穿整个研究，n=24）、BI 晚期（最初 BAU，然后交叉至 BI，n=22）和整个研究期间的 BAU（n=14）。
55 例最初纳入的患者完成了随访。BI 早期组在 16 个月的观察期间，每月头痛和用药天数分别减少了 8.4（5.4-11.4）和 13.5（9.6-17.3）。药物过度使用的复发率为 8.3%。BI 后，BI 晚期组患者也显著改善。BAU 组无明显改善。
初级保健医生通过 BI 治疗 MOH 是一种简单的干预措施，具有持久的疗效和较低的复发率。这种方法可能是 MOH 治疗的合理第一步，一般应将转介保留给初级保健非应答者。
