title: Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years.
abstract: OBJECTIVE
  To determine whether combined treatment using medication and biofeedback would be more effective than drug treatment alone for treating transformed migraine complicated by analgesic overuse.
  
  
  BACKGROUND
  Headaches that are chronic, daily, and aggravated by medication overuse are particularly difficult to treat.
  
  
  METHODS
  Sixty-one consecutive patients with transformed migraine and analgesic overuse were treated with inpatient pharmacologic therapy alone or with inpatient pharmacologic therapy combined with biofeedback-assisted relaxation. All patients then were followed prospectively for 3 years.
  
  
  RESULTS
  Both treatment groups exhibited similar levels of improvement immediately following treatment and for 1 year thereafter. At year 3, participants receiving combined treatment showed greater sustained improvement on two of three outcome measures assessed (ie, fewer days of headache and reduced consumption of analgesic medication). In addition, a greater number of patients assigned to pharmacologic treatment alone relapsed (ie, resumed overuse of analgesics) compared to patients receiving combined treatment.
  
  
  CONCLUSIONS
  These results suggest that a combination of pharmacologic and behavioral treatment is more effective than drug therapy alone in the long-term management of transformed migraine with analgesic overuse. Confirmation of these findings, as well as extension to other forms of behavioral and cognitive-behavioral treatment, is required.
authors.affiliation: Headache Center, National Neurological Institute C. Besta, Milan, Italy.
authors.forename: Licia
authors.initials: L
authors.lastname: Grazzi
authors.forename: Frank
authors.initials: F
authors.lastname: Andrasik
authors.forename: Domenico
authors.initials: D
authors.lastname: D'Amico
authors.forename: Massimo
authors.initials: M
authors.lastname: Leone
authors.forename: Susanna
authors.initials: S
authors.lastname: Usai
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Kass
authors.forename: Gennaro
authors.initials: G
authors.lastname: Bussone
mesh_terms: D000328:Adult; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D001676:Biofeedback, Psychology; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000139:chemically induced / Q000188:drug therapy* / Q000628:therapy; D011446:Prospective Studies; D012064:Relaxation Therapy
chemical_list: D000700:Analgesics