title: Prevention of medication overuse in patients with migraine.
abstract: This multi-center study compared the therapeutic effect of a cognitive-behavioral minimal contact program (MCT) to the effect of a brochure (bibliotherapy) for the prevention of medication overuse headache (MOH) in migraine patients. Seven German headache centers recruited 182 migraine patients with high triptan or analgesic intake frequency. Patients were randomly allocated to either the MCT-group, receiving both an MCT program and an educational brochure or to the biblio-group receiving only the brochure. All participants continued usual medical treatment. Course of headaches, intake of analgesics or triptans after training, 3 months post-training as well as 1-2 years (mean 15.7 months) later and psychological variables were defined as outcome variables. A significant decline was observed in the number of headache days (11.0-8.8), migraine days (7.3-5.7) and medication intake days (7.4-6.1) from pre to post in the MCT-group (p<0.001 each) and in the biblio-group (p<0.001 each). The pre-to-post-improvements were maintained from pre- to short- and from pre- to long-term follow-up (p<0.001 each) in both groups. Both groups improved significantly from pre to post in psychological variables, e.g. pain acceptance: p<0.001; pain catastrophizing: p<0.001; functional pain coping: p<0.001; and pain related internal control beliefs: p<0.01. Psychological improvements remained stable in both groups at short- and long-term follow-up. During the study, none of the patients developed an MOH. MCT- and bibliotherapy are useful in migraine patients to prevent medication overuse headache or the transition of episodic to chronic headache.
authors.affiliation: Department of Neurology and Headache Center, University Hospital Essen, Germany Department of Neurology, University Hospital Halle, Germany Department of Pain Management, BG-Klinikum Bergmannsheil, University Hospital Bochum, Germany Department of Anaesthesiology, University of Luebeck, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Fritsche
authors.forename: Jule
authors.initials: J
authors.lastname: Frettlöh
authors.forename: Michael
authors.initials: M
authors.lastname: Hüppe
authors.forename: Martha
authors.initials: M
authors.lastname: Dlugaj
authors.forename: Nadine
authors.initials: N
authors.lastname: Matatko
authors.forename: Charly
authors.initials: C
authors.lastname: Gaul
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Diener
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects*; D001007:Anxiety / Q000139:chemically induced; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000139:chemically induced; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000628:therapy; D051271:Headache Disorders, Secondary / Q000139:chemically induced* / Q000517:prevention & control* / Q000523:psychology; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D008881:Migraine Disorders / Q000139:chemically induced* / Q000517:prevention & control* / Q000523:psychology; D017060:Patient Satisfaction; D011594:Psychometrics; D012648:Self Care; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics
references.citation: Abt K. Descriptive data analysis: a concept between confirmatory and exploratory data analysis. Methods Inf Med. 1987;26:77-88.
references.citation: Altieri M, Di Giambattista R, Di Clemente L, Fagiolo D, Tarolla E, Mercurio A, Vicenzini E, Tarsitani L, Lenzi GL, Biondi M, Di Piero V. Combined pharmacological and short-term psychodynamic psychotherapy for probable medication overuse headache: a pilot study. Cephalalgia. 2009;29:293-299.
references.citation: Andrasik F. Behavioral treatment approaches to chronic headache. Neurol Sci. 2003;24:80-85.
references.citation: Basler HD, Jäkle C, Kröner-Herwig B. Cognitive-behavioral therapy for chronic headache at German pain centers. Int J Rehab Health. 1996;2:235-252.
references.citation: Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the hospital anxiety and depression scale: an updated literature review. J of Psychosom Res. 2002;25:69-77.
references.citation: Blanchard EB. Psychological treatment of benign headache disorders. J Consult Clin Psychol. 1992;60:537-551.
references.citation: Denecke H, Glier B, Klinger R, Nilges P, Redegeld M, WeiΒ L, Kröner-Herwig B. Quality assurance in therapy of chronic pain. Results obtained by a taskforce of the German Section of the Association for the Study of Pain on psychological assessment of chronic pain. Schmerz. 1995;9:39-42.
references.citation: Diener HC, Küper M, Kurth T. Migraine-associated risks and comorbidity. J Neurol. 2008;255:1290-1301.
references.citation: Evers S, Afra J, Frese A, Goadsby PJ, Linde M, May A, et al. EFNS guideline on the drug treatment of migraine – report of an EFNS task force. Eur J Neurol. 2006;13:560-572.
references.citation: Flor H, Behle DJ, Birbaumer N. Assessment of pain-related cognitions in chronic pain patients. Behav Res Ther. 1993;31:63-73.
references.citation: Fritsche G, Hueppe M, Kukava M, Dzagnidze A, Schuerks M, Yoon MS, Diener HC, Katsarava Z. Validation of a german language questionnaire for screening for migraine, tension-type headache, and trigeminal autonomic cephalgias. Headache. 2007;47:546-551.
references.citation: Fritsche G, Nitsch C, Pietrowski R, Diener HC. Psychological descriptors of excessive use of analgesic medication. Schmerz. 2000;14:217-225.
references.citation: Grazzi L, Andrasik F, D'Amico D, Leone M, Usai S, Kass SJ, Bussone G. Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years. Headache. 2002;42:483-490.
references.citation: Holroyd KA, Drew JB. Behavioral approaches to the treatment of migraine. Semin Neurol. 2006;26:199-207.
references.citation: Katsarava Z, Schneeweiss S, Kurth T, Kroener U, Fritsche G, Eikermann A, Diener HC, Limmroth V. Incidence and predictors for chronicity of headache in patients with episodic migraine. Neurology. 2004;62:788-790.
references.citation: Lu SR, Fuh JL, Chen WT, Juang KD, Wang SJ. Chronic daily headache in Taipei, Taiwan: prevalence, follow-up and outcome predictors. Cephalalgia. 2001;21:980-986.
references.citation: Marrs RW. A meta-analysis of bibliotherapy studies. Am J Community Psychol. 1995;23:843-870.
references.citation: Mathew NT, Kurman R, Perez F. Drug induced refractory headache – clinical features and management. Headache. 1990;30:634-638.
references.citation: Mathew NT. Transformed migraine. Cephalalgia. 1993;78-83.
references.citation: McCracken LM, Vowles KE, Eccleston C. Acceptance of chronic pain: component analysis and a revised assessment method. Pain. 2004;107:159-166.
references.citation: McCracken LM. Learning to live with the pain: acceptance of pain predicts adjustment in persons with chronic pain. Pain. 1998;74:21-27.
references.citation: Nicholson RA, Houle TT, Rhudy JL, Norton PJ. Psychological risk factors in headache. Headache. 2007;47:413-426.
references.citation: Nilges P, Köster B, Schmidt CO. Pain acceptance – concept and validation of a German version of the chronic pain acceptance questionnaire. Schmerz. 2007;21:60-67.
references.citation: Radat F, Creach C, Swendsen JD, Lafittau M, Irachabal S, Dousset V, Henry P. Psychiatric comorbidity in the evolution from migraine to medication overuse headache. Cephalalgia. 2005;25:519-522.
references.citation: Redillas C, Solomon S. Prophylactic pharmacologic treatment of chronic daily headache. Headache. 2000;40:83-102.
references.citation: Rosenstiel AK, Keefe FJ. The use of coping strategies in chronic low-back pain patients: Relationship to patient characteristics and current adjustment. Pain. 1983;17:33-44.
references.citation: Rotter JB. Generalized expectancies for internal versus external control of reinforcement. Psychol Monogr. 1966;80:1-28.
references.citation: Saper JR, Silberstein SD, Lake AE III, Winters ME. Double-blind trial of fluoxetine: chronic daily headache and migraine. Headache. 1994;34:497-502.
references.citation: Scher AI, Lipton RB, Stewart W. Risk factors for chronic daily headache. Curr Pain Headache Rep. 2002;6:486-491.
references.citation: Turk DC, Dworkin RH, Allen RR, Bellamy N, Brandenburg N, Carr DB, Cleeland C, Dionne R, Farrar JT, Galer BS, Hewitt DJ, Jadad AR, Katz NP, Kramer LD, Manning DC, McCormick CG, McDermott MP, McGrath P, Quessy S, Rappaport BA, Robinson JP, Royal MA, Simon L, Stauffer JW, Stein W, Tollett J, Witter J. Core outcome domains for chronic pain clinical trials: IMMPACT recommendations. Pain. 2003;106:337-345.
references.citation: Turk DC, Dworkin RH, McDermott MP, Bellamy N, Burke LB, Chandler JM, Cleeland CS, Cowan P, Dimitrova R, Farrar JT, Hertz S, Heyse JF, Iyengar S, Jadad AR, Jay GW, Jermano JA, Katz NP, Manning DC, Martin S, Max MB, McGrath P, McQuay HJ, Quessy S, Rappaport BA, Revicki DA, Rothman M, Stauffer JW, Svensson O, White RE, Witter J. Analyzing multiple endpoints in clinical trials of pain treatments: IMMPACT recommendations. Initiative on methods, measurement, and pain assessment in clinical trials. Pain. 2008;139:485-493.
references.citation: Turk DC, Rudy TE. Assessment of cognitive factors in chronic pain: a worthwhile enterprise? J Consult Clin Psychiat. 1986;54:760-768.
references.citation: Wallston KA, Wallston BS, DeVellis R. Development of the multidimensional health locus of control (MHLC) scales. Health Educ Monogr. 1978;6:160-170.
references.citation: Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiat Scand. 1983;67:361-370.
references.citation: Zwart JA, Dyb G, Hagen K, Svebak S, Holmen J. Analgesic use: a predictor of chronic pain and medication overuse headache: the Head-HUNT Study. Neurology. 2003;22:160-164.