Public Health and Disability Unit, Neurological Institute "C. Besta" IRCCS Foundation, Neurology, Milan, Italy.
e-Campus University, Novedrate, Italy.
Headache. 2018 Oct;58(9):1373-1388. doi: 10.1111/head.13385. Epub 2018 Aug 20.
It is common clinical experience that, after structured withdrawal, some patients with chronic migraine and medication overuse headache (CM with MOH) are more prone than others to relapse and to be in need of further structured treatments. Our aim was to explore similarities and differences between frequent relapsers (FRs) and non-frequent relapsers (NFRs) by considering their point of view, perceptions, and perspective of their subjective experience with relapse into CM with MOH.
Patients were consecutively recruited on occasion of a structured withdrawal treatment and were interviewed individually about their headache experience and their perspectives on relapse into CM with MOH. We considered FR those patients requiring 2 or more structured withdrawals for MOH within 3 years. A narrative approach with no preconceived coding schemes was employed. To facilitate coding, categorization and organization of data the software QRS NVivo 11.0 was used: themes were defined as common to FR and NFR, or peculiar (by frequency or content) to one of the 2 groups.
Sixteen patients (13 women; mean age of 53) were interviewed: 7 were classified as FRs. A total of 22 themes emerged from 552 single quotations (the 10 most relevant covered 82% of the entire body of quotations). Four themes were commonly reported by both FR and NFR patients, and 6 were peculiar to one group only. Common aspects included issues connected to the dilemma between disclosing, concealing and the feelings of isolation around MOH, the idea of being addicted to medication, presence of anxiety, and the attempt to use non-pharmacological therapies as an alternative to medication. Peculiar aspects included causal attribution (FRs attributed headache to uncontrollable factors); future expectations at the time point of withdrawal (FRs were generally resigned); high-performance functioning (FRs believed they are "forced" to reach high levels of performance as a consequence of others' inability); coping strategies (FRs tended to "passively accept" problems and showed avoidance-related behaviors). Moreover, FRs were less frequently aware of their problems and described more frequently depressive symptoms.
Our results highlight that some differences between FR and NFR patients with CM and MOH exist. Frequent relapsers among patients with CM and MOH reported some important peculiarities of the lived experience of having chronic migraine; clinicians should recognize these psychosocial aspects such as social relationships, future expectations, the experience of illness, medication management, and how the withdrawal experience is regarded, as they may be associated with frequent relapse into MOH.
在进行结构化撤药后，一些慢性偏头痛和药物过度使用性头痛（CM with MOH）患者比其他人更容易复发，需要进一步进行结构化治疗，这是常见的临床经验。我们的目的是通过考虑患者的观点、看法以及对复发为 CM with MOH 的主观体验，来探讨频繁复发者（FRs）和非频繁复发者（NFRs）之间的异同。
我们连续招募了进行结构化撤药治疗的患者，并对他们的头痛经历以及对复发为 CM with MOH 的看法进行了单独访谈。我们将在 3 年内需要进行 2 次或更多次 MOH 结构化撤药的患者定义为 FR。采用无预设编码方案的叙述方法。为了便于编码、分类和组织数据，我们使用了 QRS NVivo 11.0 软件：将 FR 和 NFR 共有的主题定义为共同主题，或仅 FR 或 NFR 特有的主题。
共对 16 名患者（13 名女性；平均年龄 53 岁）进行了访谈：其中 7 名被归类为 FR。从 552 个单句中共提取出 22 个主题（前 10 个最相关主题涵盖了整个引用语的 82%）。FR 和 NFR 患者共同报告了 4 个主题，只有 1 个主题是某一组特有的。共同主题包括与偏头痛治疗困境相关的问题，如隐瞒、孤立、对药物的依赖感、焦虑、试图使用非药物疗法作为药物治疗的替代；FR 特有的主题包括因果归因（FR 将头痛归因于无法控制的因素）、撤药时的未来预期（FR 通常听天由命）、高绩效表现（FR 认为由于他人的无能，他们被迫达到高绩效水平）、应对策略（FR 倾向于“被动接受”问题，并表现出回避行为）。此外，FR 对自己的问题认识不足，抑郁症状更为常见。
我们的结果表明，CM 和 MOH 患者中的 FR 和 NFR 之间存在一些差异。CM 和 MOH 患者中的频繁复发者报告了慢性偏头痛患者生活体验的一些重要特点；临床医生应认识到这些社会心理方面，如社会关系、未来预期、疾病体验、药物管理以及对撤药体验的看法，因为它们可能与 MOH 的频繁复发有关。
