title: Chronic daily headache with medication overuse: a randomized follow-up by neurologist or PCP.
abstract: 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.
authors.affiliation: Department of Neurology, Sørlandet Hospital, Kristiansand, Norway. magne.geir.boe@sshf.no
authors.forename: M G
authors.initials: MG
authors.lastname: Bøe
authors.forename: R
authors.initials: R
authors.lastname: Salvesen
authors.forename: A
authors.initials: A
authors.lastname: Mygland
mesh_terms: 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*