A Frustaci

C Tassorelli

E Guaschino

F Galli

G Nappi

G Sances

M Allena

N Ghiotto

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POSTER PRESENTATION Open Access
The “care” protocol: outcome of medication
overuse headache in a three year follow-up study
G Sances1*, N Ghiotto1, F Galli1, M Allena1, A Frustaci2, E Guaschino1, C Tassorelli1, G Nappi1
From The European Headache and Migraine Trust International Congress
London, UK. 20-23 September 2012
Introduction
Medication Overuse Headache (MOH) has become one of
the major challenges in headache management. The main
aim of the present study was to evaluate the factors asso-
ciated with a negative outcome in a three-year follow-up
of subjects diagnosed with MOH.
Methods
All consecutive patients with MOH entering, for the first
time, the centre’s inpatient detoxification program were
analyzed in a prospective, non randomized way. They
were enrolled as outpatients and gave their verbal
informed consent to undergo the protocol (inpatient
detoxification and three follow-up visits in the first year,
then six-monthly clinical controls). The diagnosis of MOH
was made according to the revised-ICHD-II criteria [1].
All the participants were assessed using an ad hoc patient’s
record form. Variables analyzed as possible predictors
were: gender, age, socio-demographic characteristics, alco-
hol/coffee/smoking habits, positive family history for drug
abuse and/or headache, past medical history, primary
headache type, type, duration and quantification of drug
overuse and duration of chronic headache. Categorical
variables were analyzed with the Chi-square test. For
quantitative variables, statistical differences were analyzed
with ANOVA. Odds Ratios (ORs) were calculated for
dichotomous outcomes as well.
Findings
One-hundred-fifty patients completed the 3-year follow-
up (79.3% females, age 46.40±11.31): 13 patients never
stopped overuse (Group A), 38 patients stopped drug
overuse, but relapsed at least once (Group B) and 99
patients never relapsed (Group C). Patients in Group A
differed from B+C groups because they were more fre-
quently single (OR 0.134;p=0.007) and unemployed
(OR=3.273;p=0.04), they took a higher number of acute
drugs (p<0.001) and used less frequently coffee (OR
3.273;p=0.044).
Conclusion
The outcome of disease in this group of MOH patients
was influenced negatively by the severity of overuse (and
possibly of the disease) and by specific socio-economic
conditions. Other factors that emerged as possible modi-
fiers of outcome were voluptuary habits.
Author details
1Headache Science Centre of the IRCCS ‘National Institute of Neurology C.
Mondino’ Foundation, Pavia, Italy. 2Clinical and Molecular Epidemiology,
IRCCS San Raffaele Pisana, Rome, Italy.
Published: 21 February 2013
Reference
1. Headache Classification Committee, Olesen J, Bousser MG, Diener HC, et al:
New appendix criteria open for a broader concept of chronic migraine.
Cephalalgia 2006, 26:742-746.
doi:10.1186/1129-2377-14-S1-P175
Cite this article as: Sances et al.: The “care” protocol: outcome of
medication overuse headache in a three year follow-up study. The
Journal of Headache and Pain 2013 14(Suppl 1):P175.
1Headache Science Centre of the IRCCS ‘National Institute of Neurology C.
Mondino’ Foundation, Pavia, Italy
Full list of author information is available at the end of the article
Sances et al. The Journal of Headache and Pain 2013, 14(Suppl 1):P175
http://www.thejournalofheadacheandpain.com/content/14/S1/P175
© 2013 Sances et al; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution
License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work is properly cited.


The “care” protocol: outcome of medication overuse headache in a three year follow-up study

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The “care” protocol: outcome of medication overuse headache in a three year follow-up study

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