Chronic daily headache with medication overuse: a randomized follow-up by neurologist or PCP.
Several studies have shown the benefit of withdrawal therapy when medication overuse headache (MOH) is suspected. Our aim was to compare the effect of withdrawal therapy in patients followed by a neurologist (group A, n = 42) and a primary care physician (PCP) (group B, n = 38). Patients were randomized to A or B, and follow-up was at 3, 6 and 12 months. Calculated mean headache (MH at 6 months + MH at 12 months)/2 (primary end-point) was similar; A 1.04 (0.87, 1.21) and B 1.02 (0.82, 1.21) (P = 0.87). The number of patients with 50% improvement of headache days was also similar; 14/42 in group A vs. 12/34 in B (P = 0.86) at 3 months, 15/42 vs. 11/33 (P = 0.83) at 6 months and 15/42 vs. 14/38 (P = 0.92) at 12 months. Days without headache during the last 9 months of follow-up were 123 (96, 150) in group A and 137 (112, 161) in B (P = 0.62). After 3 months one-third were classified as MOH. Patients with MOH improved similarly in group A and B, and so did patients without MOH. Within 1 year 7/42 in A and 9/38 in B had recurrent medication overuse (P = 0.43). In summary, there were no significant differences in follow-up results between the two groups.
Bøe
M G
MG
Department of Neurology, Sørlandet Hospital, Kristiansand, Norway. magne.geir.boe@sshf.no
Salvesen
R
R
Mygland
A
A
D000328:Adult; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D020773:Headache Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data*; D009664:Norway / Q000453:epidemiology; D010147:Pain Measurement / Q000187:drug effects / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000706:statistics & numerical data*; D015995:Prevalence; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000706:statistics & numerical data*