title: Detoxification in medication-overuse headache, a retrospective controlled follow-up study: Does care by a headache nurse lead to cure?
abstract: OBJECTIVE
  J.A.P. and M.A.L. contributed equally to this manuscript.The aim of this article is to determine whether support by a headache nurse in the treatment of medication-overuse headache (MOH) increases successful withdrawal, and to study determinants of response to withdrawal therapy.
  
  
  METHODS
  A retrospective, controlled follow-up study was performed with 416 MOH patients. All patients were treated with outpatient withdrawal therapy, with two treatment arms: with or without the support of a specialised headache nurse. The outcome measures were: i) successful withdrawal, defined as discontinuation of all headache medication according to the study protocol; and ii) the responder rate, defined as the percentage of patients with ≥ 50% reduction in headache days after successful withdrawal and iii) relative reduction in headache days after successful withdrawal.
  
  
  RESULTS
  Successful withdrawal percentages were significantly higher in the group supported by the headache nurse than in the group without support (73.1% vs. 60.7%; p = 0.008), which was confirmed in multivariate analysis (OR 1.73, 95% CI 1.11-2.71, p = 0.016). Support by a headache nurse was not associated with response. The underlying primary headache diagnosis, determined after withdrawal, was significantly correlated with response.
  
  
  CONCLUSIONS
  The support by a headache nurse results in an increased adherence to detoxification.
authors.affiliation: Department of Neurology, Leiden University Medical Centre, the Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: Pijpers
authors.affiliation: Department of Neurology, Leiden University Medical Centre, the Netherlands Department of Psychiatry, Leiden University Medical Centre, the Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Louter
authors.affiliation: Department of Neurology, Leiden University Medical Centre, the Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: de Bruin
authors.affiliation: Department of Medical Statistics, Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: E W
authors.initials: EW
authors.lastname: van Zwet
authors.affiliation: Department of Psychiatry, Leiden University Medical Centre, the Netherlands.
authors.forename: F G
authors.initials: FG
authors.lastname: Zitman
authors.affiliation: Department of Neurology, Leiden University Medical Centre, the Netherlands.
authors.forename: M D
authors.initials: MD
authors.lastname: Ferrari
authors.affiliation: Department of Neurology, Leiden University Medical Centre, the Netherlands g.m.terwindt@lumc.nl.
authors.forename: G M
authors.initials: GM
authors.lastname: Terwindt
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D051271:Headache Disorders, Secondary / Q000139:chemically induced* / Q000451:nursing*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013375:Substance Withdrawal Syndrome / Q000451:nursing*; D019966:Substance-Related Disorders / Q000451:nursing*
keywords: Medication overuse; headache nurse; medication-overuse headache; migraine; treatment