title: Brief intervention by general practitioners for medication-overuse headache, follow-up after 6 months: a pragmatic cluster-randomised controlled trial.
abstract: Medication-overuse headache (MOH) is a common health problem. Withdrawal of the overused medication is the treatment of choice. We investigated the long-term effectiveness of brief intervention (BI) for MOH patients in primary care. The BI for MOH in primary care study was a blinded, pragmatic, cluster-randomised controlled trial. 25,486 patients (age 18-50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and 23 GPs were randomised to receive BI training and 27 GPs to continue business as usual (BAU). The GPs assessed their MOH patients with the Severity of Dependence Scale, gave individual feedback about the risk of MOH and advice to reduce headache medication. Primary outcomes, assessed 6 months after the intervention, were reduction in headache and medication days/month. 42% were screening responders. 2.4% had self-reported MOH. A random selection of 104 patients with self-reported MOH were invited, 75 were randomised out of which 60 with a physician-defined MOH diagnosis were included. None were lost to follow-up. BI was significantly better than BAU regarding primary outcomes (p < 0.001-0.018). Headache and medication days were reduced by 5.9 (95% CI 1.1-10.8) and 6.2 (1.1-11.3) more days/month in BI than BAU group. Chronic headache resolved in 63 and 11% in the BI and the BAU group (p < 0.001). Headache-related disability was lower among those who detoxified. In conclusion, BI is an effective treatment in primary care with lasting effect 6 months after the intervention for MOH.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01314768.
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Blindern, PO Box 1130, 0318, Oslo, Norway. e.s.kristoffersen@medisin.uio.no.|HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway. e.s.kristoffersen@medisin.uio.no.
authors.forename: Espen Saxhaug
authors.initials: ES
authors.lastname: Kristoffersen
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Blindern, PO Box 1130, 0318, 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.
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; D000369:Aged, 80 and over; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners / Q000193:education*; D051271:Headache Disorders, Secondary / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D055815:Young Adult
keywords: Cluster-randomised trial; General practice; Medication-overuse headache; Migraine; Screening and brief intervention; Severity of dependence scale