title: Predictors of 12-Months Relapse After Withdrawal Treatment in Hospitalized Patients With Chronic Migraine Associated With Medication Overuse: A Longitudinal Observational Study.
abstract: BACKGROUND
  Studies addressing relapse rates conflate relapse into chronic migraine (CM) and medication overuse (MO), and the consequent need to repeat withdrawal. We aim to identify 12-months predictors of relapse into CM (based on headaches frequency) separately from occurrence of another structured withdrawal.
  
  
  METHODS
  Hospitalized patients with CM-MO under withdrawal were enrolled. Candidate predictors included demographic, disability, quality of life, depression scores, general self-efficacy, social support, headaches frequency and intensity, class of overused medications, history of withdrawal treatment in the three years prior to enrollment, attendance to emergency room (ER) between enrollment and follow-up, nonattendance to outpatient neurological examinations. Logistic regressions was used to address the significant predictors for the two outcomes.
  
  
  RESULTS
  Complete data were available for 177 patients: 60 (33.9%) relapsed into CM, 38 (21.5%) underwent another withdrawal treatment. Recent history of withdrawal treatments, ER admission after discharge and high baseline BDI-II scores were significant predictors in both models. In addition to this, high baseline headache frequency predicted relapse into another withdrawal treatment.
  
  
  CONCLUSIONS
  Predictors or relapse into CM and of occurrence of another withdrawal by 12-months are somehow similar. It is important to assess presence of recent previous withdrawal treatments and to plan regular follow-up afterwards, in particular for patients with high headache frequency and relevant mood disturbances: in this way, it will be more likely that situations requiring further structured withdrawal treatments can be identified before patients have to refer to ER.
authors.affiliation: Neurology, Public Health and Disability Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
authors.forename: Alberto
authors.identifier: http://orcid.org/0000-0002-7433-7779
authors.initials: A
authors.lastname: Raggi
authors.affiliation: Neurology, Public Health and Disability Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
authors.forename: Ambra M
authors.initials: AM
authors.lastname: Giovannetti
authors.affiliation: Neurology, Public Health and Disability Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
authors.forename: Matilde
authors.initials: M
authors.lastname: Leonardi
authors.affiliation: Neurology, Public Health and Disability Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Sansone
authors.affiliation: Neurology, Public Health and Disability Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Schiavolin
authors.affiliation: Headache and Neuroalgology Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
authors.forename: Marcella
authors.initials: M
authors.lastname: Curone
authors.affiliation: Headache and Neuroalgology Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
authors.forename: Licia
authors.initials: L
authors.lastname: Grazzi
authors.affiliation: Headache and Neuroalgology Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
authors.forename: Susanna
authors.initials: S
authors.lastname: Usai
authors.affiliation: Headache and Neuroalgology Unit, Neurological Institute "C. Besta" IRCCS Foundation, Milan, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: D'Amico
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D051271:Headache Disorders, Secondary / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D007297:Inpatients; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D012008:Recurrence
keywords: chronic migraine; depression; emergency room; medication overuse; relapse rate; withdrawal treatment