title: Medication overuse, healthy lifestyle behaviour and stress in chronic headache: Results from a population-based representative survey.
abstract: OBJECTIVE
  This cross-sectional study investigated associations between chronic headache (CH) with and without medication overuse, healthy lifestyle behaviour, and stress.
  
  
  METHODS
  Questionnaires were sent to 129,150 adults. Those with headache ≥15 days per month for three months were classified as having CH then further described as having medication-overuse headache (MOH) or CH without medication overuse. Associations between headache and daily smoking, physical inactivity, obesity, excessive drinking, illicit drug use, and high stress were analysed by logistic regression.
  
  
  RESULTS
  CH with and without medication overuse (prevalence 1.8% and 1.6%, respectively) had strong, graded associations with stress. Associations with daily smoking, physical inactivity, and obesity were significant only for MOH. Odds for MOH were highest among people who had all three factors compared to those who had none (OR 2.8 in women and 5.1 in men). High stress plus any of these three factors had synergistic effects in MOH but not clearly in those who had CH without overuse. Associations between CH subtypes and excessive drinking or illicit drug use were not statistically significant.
  
  
  CONCLUSIONS
  Results suggest strong links between healthy lifestyle behaviour and stress in MOH. Stress reduction and promoting healthy behaviour are highly relevant in MOH management.
authors: Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark mlwestergaard@dadlnet.dk.
authors: Maria Lurenda
authors: ML
authors: Westergaard
authors: Research Center for Prevention and Health, Capital Region of Denmark, Denmark Department of Health Science and Technology, University of Aalborg, Denmark.
authors: Charlotte
authors: C
authors: Glümer
authors: Department of Pharmacy, University of Copenhagen, Denmark.
authors: Ebba Holme
authors: EH
authors: Hansen
authors: Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.
authors: Rigmor Højland
authors: RH
authors: Jensen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D020773:Headache Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D051271:Headache Disorders, Secondary / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015438:Health Behavior; D006306:Health Surveys / Q000379:methods; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012307:Risk Factors; D040242:Risk Reduction Behavior; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D055815:Young Adult
keywords: Chronic headache; alcohol abuse; health behaviour; illicit drugs; life stress; medication-overuse headache; obesity; secondary headache disorders; sedentary lifestyle; smoking