Comprehensive inpatient treatment of refractory chronic daily headache.
OBJECTIVE
(1) To assess outcome at discharge for a consecutive series of admissions to a comprehensive, multidisciplinary inpatient headache unit; (2) To identify outcome predictors.


BACKGROUND
An evidence-based assessment (2004) concluded that many refractory headache patients appear to benefit from inpatient treatment, underscoring the need for more research, including outcome predictors.


METHODS
The authors completed a retrospective chart review of 283 consecutive admissions over 6 months. The inpatient program (mean length of stay = 13.0 days) included intravenous and oral medication protocols, drug withdrawal when indicated, cognitive-behavior therapy, and other services when needed, including anesthesiological intervention. Patient-reported pain levels and consensus of medical staff determined outcome status.


RESULTS
The 267 completers (94%) included 212 women and 55 men (mean age = 40.3 years, range = 13-74) from 43 states and Canada. The modal diagnosis was intractable, chronic daily headache (85%), predominantly migraine. Most (59%) had medication overuse headache (MOH), involving opioids (48%), triptans (16%), or butalbital-containing analgesics (10%). Psychiatric diagnoses included stress-related headache (82%), mood disorders (70%), anxiety disorders (49%), and personality disorders (PD, 26%). More patients with a PD (62%) had opioid-related MOH than those with no PD (38%), P < .005. Of the completers, 78% had moderate to significant pain reduction, with comparable improvement in mood, function, and behavior. Clinical factors predicting moderate-significant headache improvement were limited to MOH (84% vs 69%, P < .007) and presence of a PD (68% vs 81%, P < .03).


CONCLUSIONS
Most patients (78%) improved following aggressive, comprehensive inpatient treatment. Maintenance of improvement is likely to depend on multiple post-discharge factors, including continuity of care, compliance, and home or work environment.
Lake
Alvin E
AE
Michigan Head-Pain and Neurological Institute, Ann Arbor, MI 48104, USA.
Saper
Joel R
JR
Hamel
Robert L
RL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D055094:Evidence-Based Dentistry; D005260:Female; D005500:Follow-Up Studies; D020773:Headache Disorders / Q000188:drug therapy*; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
D000700:Analgesics