Behavioral dependence in patients with medication overuse headache: a cross-sectional study in consulting patients using the DSM-IV criteria.
OBJECTIVE
The aim of this study was to assess behavioral dependence on migraine abortive drugs in medication-overuse headache (MOH) patients and identify the predisposing factors.


BACKGROUND
It is common occurrence that MOH patients relapse after medication withdrawal. Behavioral determinants of medication overuse should therefore be identified in MOH patients.


METHODS
This was a cross-sectional, multicenter study that included 247 MOH patients (according to International Classification of Headache Disorders, 2nd edition criteria) consulting in French headache specialty centers. Face-to-face interviews were conducted by senior neurologists using a structured questionnaire including the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for the evaluation of dependence, Hospital Anxiety and Depression Scale for the evaluation of anxiety and depression, and 6-item short-form Headache Impact Test scale for the determination of functional impact.


RESULTS
Most MOH patients had pre-existing primary migraine (87.4%) and current migraine-type headaches (83.0%). Treatments overused included triptans (45.8%), opioid analgesics alone or in combination (43.3% of patients), and analgesics (27.9%). Nonmigraine abortive substances (tobacco, caffeine, sedatives/anxiolytics) were overused by 13.8% of patients. Two-thirds of MOH patients (66.8%) were considered dependent on acute treatments of headaches according to the DSM-IV criteria. Most dependent MOH patients had migraine as pre-existing primary headache (85.7%) and current migraine-type headaches (87.9%), and most of them overused opioid analgesics. More dependent than nondependent MOH patients were dependent on psychoactive substances (17.6% vs 6.1%). Multivariate logistic analysis indicated that risk factors of dependence on acute treatments of headaches pertained both to the underlying disease (history of migraine, unilateral headaches) and to drug addiction (opioid overuse, previous withdrawal). Affective symptoms did not appear among the predictive factors of dependence.


CONCLUSIONS
In some cases, MOH thus appears to belong to the spectrum of addictive behaviors. In clinical practice, behavioral management of MOH should be undertaken besides pharmacological management.
Radat
Françoise
F
Department of Treatment of Chronic Pain Patients, Pellegrin University Hospital, Bordeaux, France.
Creac'h
Christelle
C
Guegan-Massardier
Evelyne
E
Mick
Gérard
G
Guy
Nathalie
N
Fabre
Nelly
N
Giraud
Pierric
P
Nachit-Ouinekh
Fatima
F
Lantéri-Minet
Michel
M
D000328:Adult; D000700:Analgesics / Q000009:adverse effects*; D016739:Behavior, Addictive / Q000145:classification / Q000175:diagnosis / Q000523:psychology*; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D051271:Headache Disorders, Secondary / Q000145:classification / Q000175:diagnosis / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019966:Substance-Related Disorders / Q000145:classification / Q000175:diagnosis / Q000523:psychology*
D000700:Analgesics