title: Predictors of successful primary care detoxification treatment for medication-overuse headache.
abstract: OBJECTIVE
  To investigate predictors for successful treatment outcome after a brief intervention (BI) for medication-overuse headache (MOH).
  
  
  METHODS
  This study evaluated predictors of successful withdrawal among patients initially participating in a pragmatic cluster-randomized controlled trial with single crossover in Norwegian general practice (the BIMOH study). BI (early or after crossover) was compared to business as usual (BAU) for the treatment of MOH. Patients were followed up 3 months after the BI.
  
  
  RESULTS
  In total, 46 patients had the chance to receive the BI (24 early and 22 after crossover) and were included in the predictor analyses. The mean reduction in headache and medication days/month from baseline for the BI was 6.9 (95% CI: 4.8-9.1) and 10.9 (8.1-13.6). The mean percentage reduction in headache and medication days was 30.5% (21.4-39.7) and 50.4% (39.5-61.3). Only five patients started prophylactic medication. Neither age, gender, co-occurrence of migraine, main type of overused drug at baseline nor Severity of Dependence Scale score at baseline predicted successful withdrawal in the prespecified analyses. Headache days/month and medication use at baseline were significant predictors in exploratory analyses with more headache and medication days predicting worse outcome.
  
  
  CONCLUSIONS
  Brief intervention for MOH is a simple and effective intervention in primary care. As the only identified predictors were frequency of headache and medication use, we conclude that treatment for all MOH patients should be attempted in primary care before referral. A raised awareness of MOH is important, as the condition is highly preventable and treatable.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01314768.
authors.affiliation: Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.|HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.|Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
authors.forename: E S
authors.identifier: http://orcid.org/0000-0002-8999-5424
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: HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.|Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway.
authors.forename: J Š
authors.initials: JŠ
authors.lastname: Benth
authors.affiliation: Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway.|Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog, Norway.
authors.forename: M B
authors.initials: MB
authors.lastname: Russell
authors.affiliation: HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.|Department of Neurology, Akershus University Hospital, Lørenskog, Norway.|Institute of Clinical Medicine, Campus Akershus University Hospital, University of Oslo, Nordbyhagen, Norway.
authors.forename: C
authors.initials: C
authors.lastname: Lundqvist
mesh_terms: D000328:Adult; D000700:Analgesics / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D005260:Female; D051271:Headache Disorders, Secondary / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D011320:Primary Health Care / Q000379:methods* / Q000592:standards
chemical_list: D000700:Analgesics
keywords: brief intervention; chronic headache; general practice; migraine