Abstract and Introduction
Background Medication-overuse headache (MOH) is common in the general population. We investigated effectiveness of brief intervention (BI) for achieving drug withdrawal in primary care patients with MOH.
Methods The study was double-blind, pragmatic and cluster-randomised controlled. A total of 25 486 patients (age 18–50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and were randomised to receive BI training (23 GPs) or to continue business as usual (BAU; 27 GPs). The Severity of Dependence Scale was applied as a part of the BI. BI involved feedback about individual risk of MOH and how to reduce overuse. Primary outcome measures were reduction in medication and headache days/month 3 months after the intervention and were assessed by a blinded clinical investigator.
Results 42% responded to the postal screening questionnaire, and 2.4% screened positive for MOH. A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study. BI was significantly better than BAU for the primary outcomes (p<0.001). Headache and medication days were reduced by 7.3 and 7.9 (95% CI 3.2 to 11.3 and 3.2 to 12.5) days/month in the BI compared with the BAU group. Chronic headache resolved in 50% of the BI and 6% of the BAU group.
Conclusions The BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH.
Headache is among the top 10 causes of morbidity, measured as years of life lost to disability. Chronic headache, that is, headache ≥15 days/month affects 2–5% of the general population. About half of those with chronic headache have medication-overuse headache (MOH). MOH is defined as the use of headache medication ≥10–15 days/month (depending on type of medication) for at least 3 months. It has a large impact on quality of life, and is probably the most costly headache disorder. MOH is regarded as a challenge to treat. Based on sound reasoning and expert opinion, current consensus suggests that withdrawal of the overused medication(s) lead to improvement of the headache, after initial worsening for 1–2 weeks.
However, because most patients with MOH consult their general practitioner (GP) and observational data support that simple advice may be effective, the primary care setting should be tested as an appropriate setting.
MOH can be identified through screening for headache frequency and dependency-like behaviour using the five simple questions of the Severity of Dependence Scale (SDS). Brief intervention (BI) involves a short screening instrument followed by individual feedback including information on why and how to reduce using of the substance in question. BI has successfully been applied to manage overuse of alcohol and different drugs in general practice. We have tailored a BI for management of MOH. The aim of this study was to test the effectiveness of the BI method versus business as usual (BAU) for achieving drug withdrawal and headache improvement in patients with MOH in general practice.