title: Medication-overuse headache in China: clinical profile, and an evaluation of the ICHD-3 beta diagnostic criteria.
abstract: BACKGROUND
  Although medication-overuse headache (MOH) is common in China, its clinical profile is not yet fully established. Meanwhile, ICHD-3 beta has been published, but its diagnostic criteria require further validation.
  
  
  METHODS
  We retrospectively classified the clinical features of 240 consecutive patients with MOH (55 males, 185 females), whose demographic data, headache features, overused medications (type, quantity, frequency and duration of use), headache-attributed burden, and outcomes were reviewed. We then applied the criteria of the several versions of ICHD (II, IIR and 3-beta) to these patients.
  
  
  RESULTS
  Compared with those with other headaches, patients with MOH were more likely to be less well educated (64.6% vs 42.0% for secondary school or lower, p < 0.0001), and on lower annual incomes (72.3% vs 56.0% for an income of Chinese yuan (CNY) 30,000 or less, p < 0.0001). Combination analgesics were the most commonly overused medications, and, caffeine (89.9%), aminopyrine (70.0%), phenacetin (53.9%) and phenobarbital (48.8%) were the most commonly used specific components of these. Only two patients (0.8%) had previously been given the diagnosis of MOH; accordingly, the median time to diagnosis after the estimated onset of the disorder was 4.0 years. The majority of patients (83.7%) improved with treatment. All 240 patients fulfilled the diagnostic criteria for MOH according to ICHD-3 beta; only 134 (55.8%) satisfied the diagnostic criteria for definite MOH according to ICHD-II, while 195 (81.2%) met those of ICHD-IIR.
  
  
  CONCLUSIONS
  MOH in China is associated with lower educational level and annual income. MOH has rarely been diagnosed and correctly treated in China. ICHD-3 beta appears to be more appropriate for the diagnosis of MOH than previous versions.
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China.
authors.forename: Zhao
authors.initials: Z
authors.lastname: Dong
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China.
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neuroscience, Norwegian University of Science and Technology, Norway Division of Brain Sciences, Imperial College London, UK.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Steiner
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China.
authors.forename: Lei
authors.initials: L
authors.lastname: Hou
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China.
authors.forename: Hai
authors.initials: H
authors.lastname: Di
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China.
authors.forename: Mianwang
authors.initials: M
authors.lastname: He
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Dai
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China.
authors.forename: Meiyan
authors.initials: M
authors.lastname: Pan
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China.
authors.forename: Mingjie
authors.initials: M
authors.lastname: Zhang
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China.
authors.forename: Ruozhuo
authors.initials: R
authors.lastname: Liu
authors.affiliation: International Headache Center, Department of Neurology, Chinese PLA General Hospital, PR China yusy1963@126.com.
authors.forename: Shengyuan
authors.initials: S
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D051271:Headache Disorders, Secondary / Q000175:diagnosis* / Q000453:epidemiology*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged
keywords: China; ICHD-3 beta; Medication-overuse headache; clinical features; diagnostic criteria