title: Medication overuse headache in Europe and Latin America: general demographic and clinical characteristics, referral pathways and national distribution of painkillers in a descriptive, multinational, multicenter study.
abstract: BACKGROUND
  Medication overuse headache (MOH) is a very disabling and costly disorder due to indirect costs, medication and healthcare utilization. The aim of the study was to describe general demographic and clinical characteristics of MOH, along with the national referral pathways and national painkillers distribution in several European and Latin American (LA) Countries.
  
  
  METHODS
  This descriptive cross-sectional observational study included 669 patients with MOH referred to headache-centers in Europe and LA as a part of the COMOESTAS project. Information about acute medication and healthcare utilization were collected by extensive questionnaires, supplemented with structured patient interviews.
  
  
  RESULTS
  Triptans were overused by 31 % European patients and by 6 % in LA (p < 0.001), whereas ergotamines were overused by 4 % in Europe and 72 % in LA (p < 0.001). Simple analgesics were overused by 54 % in Europe and by 33 % in LA (p < 0.001), while combination-analgesics were more equally overused (24 % in Europe and 29 % in LA). More European patients (57 %) compared with LA patients (27 %) visited general practitioners (p < 0.001), and 83 % of European patients compared to 38 % in LA consulted headache specialists (p < 0.001). A total of 20 % in Europe and 30 % in LA visited emergency rooms (p = 0.007).
  
  
  CONCLUSIONS
  There are marked variations between LA and Europe in healthcare pathways and in acute medication overuse regarding patients with MOH. This should be considered when planning prevention campaigns against MOH.
authors.affiliation: Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark.|Danish Headache Center, Neurological Department, Glostrup Hospital, Glostrup, Denmark.
authors.forename: Ninett Louise
authors.initials: NL
authors.lastname: Find
authors.affiliation: Danish Headache Center, Neurological Department, Glostrup Hospital, Glostrup, Denmark.|Department of Biomedical and NeuroMotor Sciences (DIBINEM), Alma Mater Studiorum, Bologna University, Ospedale Bellaria, Bologna, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Terlizzi
authors.affiliation: Danish Headache Center, Neurological Department, Glostrup Hospital, Glostrup, Denmark.
authors.forename: Signe Bruun
authors.initials: SB
authors.lastname: Munksgaard
authors.affiliation: Danish Headache Center, Neurological Department, Glostrup Hospital, Glostrup, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Bendtsen
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute C. Mondino Foundation, Dept. of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Tassorelli
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute C. Mondino Foundation, Dept. of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nappi
authors.affiliation: Department of Neurology, University Hospital of Essen, Essen, Germany.
authors.forename: Zaza
authors.initials: Z
authors.lastname: Katsarava
authors.affiliation: Foundation of the Valencian Community, University Clinical Hospital, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Lainez
authors.affiliation: Foundation for Combating Neurological Diseases of Childhood, Buenos Aires, Argentina.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Goicochea
authors.affiliation: Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Shand
authors.affiliation: Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Fadic
authors.affiliation: Universidad Isalud, Buenos Aires, Argentina.
authors.forename: Santiago
authors.initials: S
authors.lastname: Spadafora
authors.affiliation: Bioengineering and Medical Informatics Consortium, Pavia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Pagani
authors.affiliation: Danish Headache Center, Neurological Department, Glostrup Hospital, Glostrup, Denmark. rigmor.jensen@regionh.dk.
authors.forename: Rigmor
authors.initials: R
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004879:Ergotamines / Q000009:adverse effects* / Q000627:therapeutic use; D005060:Europe; D005260:Female; D051271:Headache Disorders, Secondary / Q000139:chemically induced*; D006801:Humans; D007843:Latin America; D008297:Male; D008875:Middle Aged; D000067490:Prescription Drug Overuse; D014363:Tryptamines / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D004879:Ergotamines; D014363:Tryptamines
keywords: Healthcare utilization; International variation; Medication overuse headache; Overuse of acute medication