title: Disability, anxiety and depression in patients with medication-overuse headache in primary care - the BIMOH study.
abstract: OBJECTIVE
  Medication-overuse headache (MOH) is common in the general population. Detoxification is the general treatment principle for MOH. The present paper is based on a study of a brief intervention (BI) for MOH in primary care. New data on headache disability and the Hospital Anxiety and Depression Scale (HADS) for MOH patients compared to population controls with and without chronic headache are presented and compared to previously published main outcome data.
  
  
  METHODS
  This was a double-blind pragmatic cluster randomized controlled trial carried out amongst 50 general practitioners in Norway. The BI was compared to business as usual (BAU) and population controls, and patients were followed up after 3 months. Primary outcomes were headache and medication days per month after 3 months. Headache disability and HADS were also measured as secondary outcomes.
  
  
  RESULTS
  Sixty MOH patients and 40 population controls were included. BI was significantly better than BAU after 3 months regarding primary outcomes. Non-intervention population controls did not change. The MOH patients had significantly higher headache disability and anxiety scores than the population controls.
  
  
  CONCLUSIONS
  Patients with MOH are a highly disabled group where anxiety and depression are important comorbidities. Detoxification of MOH by a BI in primary care is effective and has potential for saving resources for more treatment-resistant cases in neurologist care.
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: E S
authors.initials: ES
authors.lastname: Kristoffersen
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
authors.forename: J
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.
authors.forename: M B
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, Lørenskog, Norway.
authors.forename: C
authors.initials: C
authors.lastname: Lundqvist
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D006233:Persons with Disabilities; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D051271:Headache Disorders, Secondary / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000453:epidemiology; D009664:Norway / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care
keywords: brief intervention; chronic headache; general practice; migraine; quality of life