title: The Severity of Dependence Scale detects people with medication overuse: the Akershus study of chronic headache.
abstract: OBJECTIVE
  To evaluate the Severity of Dependence Scale (SDS) in people with primary chronic headache and analyse the pattern of medication overuse.
  
  
  METHODS
  Cross sectional epidemiological survey. A posted questionnaire screened for chronic headache. Neurological residents interviewed those with self-reported chronic headache. The International Classification of Headache Disorders was used. Split file methodology was employed for data analysis.
  
  
  METHODS
  Akershus University Hospital, Oslo, Norway.
  
  
  METHODS
  A random sample of 30,000 people, aged 30-44 years, from the general population of Akershus County, Norway. 405 people had primary chronic headache.
  
  
  METHODS
  SDS score in those with and without medication overuse.
  
  
  RESULTS
  The screening questionnaire response rate was 71% and the participation rate of the interview 74%. Among 405 people with primary chronic headache, 95% had chronic tension-type headache, 4% had chronic migraine and <1% had other primary chronic headaches. Of 386 persons with chronic tension-type headache, 44% had medication overuse and 47% had co-occurrence of migraine. Simple analgesics, combination analgesics, triptans, ergotamine, opioids and a combination of acute medications were overused by 65%, 27%, 4%, <1%, 1% and 2% of people, respectively. The mean SDS score was significantly higher in those with than in those without medication overuse (5.6 vs 2.7; p<0.001).
  
  
  CONCLUSIONS
  The SDS questionnaire detects medication overuse and dependency-like behaviour in persons with primary chronic headache.
authors.affiliation: Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog 1478, Norway. r.berling.grande@medisin.uio.no
authors.forename: R B
authors.initials: RB
authors.lastname: Grande
authors.forename: K
authors.initials: K
authors.lastname: Aaseth
authors.forename: J
authors.initials: J
authors.lastname: Saltyte Benth
authors.forename: P
authors.initials: P
authors.lastname: Gulbrandsen
authors.forename: M B
authors.initials: MB
authors.lastname: Russell
authors.forename: C
authors.initials: C
authors.lastname: Lundqvist
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D000704:Analysis of Variance; D015897:Comorbidity; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D004878:Ergotamine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D020773:Headache Disorders / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000188:drug therapy / Q000453:epidemiology; D009664:Norway / Q000453:epidemiology; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D011795:Surveys and Questionnaires; D018781:Tension-Type Headache / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome; D014363:Tryptamines / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D014363:Tryptamines; D004878:Ergotamine