title: Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial.
abstract: BACKGROUND
  Medication-overuse headache (MOH) is common in the general population. We investigated effectiveness of brief intervention (BI) for achieving drug withdrawal in primary care patients with MOH.
  
  
  METHODS
  The study was double-blind, pragmatic and cluster-randomised controlled. A total of 25,486 patients (age 18-50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and were randomised to receive BI training (23 GPs) or to continue business as usual (BAU; 27 GPs). The Severity of Dependence Scale was applied as a part of the BI. BI involved feedback about individual risk of MOH and how to reduce overuse. Primary outcome measures were reduction in medication and headache days/month 3 months after the intervention and were assessed by a blinded clinical investigator.
  
  
  RESULTS
  42% responded to the postal screening questionnaire, and 2.4% screened positive for MOH. A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study. BI was significantly better than BAU for the primary outcomes (p<0.001). Headache and medication days were reduced by 7.3 and 7.9 (95% CI 3.2 to 11.3 and 3.2 to 12.5) days/month in the BI compared with the BAU group. Chronic headache resolved in 50% of the BI and 6% of the BAU group.
  
  
  CONCLUSIONS
  The BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH.
  
  
  BACKGROUND
  NCT01314768.
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.
authors.forename: Espen Saxhaug
authors.initials: ES
authors.lastname: Kristoffersen
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: Jørund
authors.initials: J
authors.lastname: Straand
authors.affiliation: Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway.
authors.forename: Kjersti Grøtta
authors.initials: KG
authors.lastname: Vetvik
authors.affiliation: HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway.
authors.forename: Jūratė Šaltytė
authors.initials: JŠ
authors.lastname: Benth
authors.affiliation: Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway.
authors.forename: Michael Bjørn
authors.initials: MB
authors.lastname: Russell
authors.affiliation: HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway Department of Neurology, Akershus University Hospital, Nordbyhagen, Norway.
authors.forename: Christofer
authors.initials: C
authors.lastname: Lundqvist
mesh_terms: D000293:Adolescent; D000328:Adult; D000700:Analgesics / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D051271:Headache Disorders, Secondary / Q000139:chemically induced* / Q000150:complications / Q000628:therapy*; D006801:Humans; D008297:Male; D011320:Primary Health Care; D011614:Psychotherapy, Brief; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics
keywords: HEADACHE; MIGRAINE; PAIN
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