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Role of educational programs in management of patients with medication-overuse headache

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Patients with primary headaches are prone to frequent uncontrolled use of analgesics, leading to medication-overuse headache (MOH). One of the most accessible and effective strategies for its prevention is informing patients about the potential danger of its development. For this, training programs («schools») are conducted.

Objective: to evaluate the effectiveness of educational programs in management of patients with MOH and its prevention.

Patients and methods. We included 120 patients (12 men and 108 women, mean age: men – 46.3±3.54 years, women – 41.3±9.5 years) with primary headache and MOH. The follow-up period was 12 months. First, patients were divided into two groups depending on the clinical diagnosis: group I (n=44) – patients with chronic primary headaches without MOH, group II (n=76) – patients with chronic primary headaches and MOH. Then, patients in each group were randomized into subgroups depending on the prescribed therapy. All participants underwent repeated clinical examinations and questionnaires assessment at 1-, 3- and 12-months follow-ups. In addition, all patients kept a headache diary. An educational «school» developed for this study was held in those subgroups where educational programs were specified.

Results and discussion. We observed a significant decrease in mean Headache-Attributed Lost Time (HALT) and Headache Impact Test (HIT-6) scores (р<0,05) at 12-months follow-up in subgroups where headache educational programs were combined with drug therapy, compared to the subgroups without educational programs. At the end of follow-up, we found a mean 1.75-fold increase in patients' treatment satisfaction (compared to baseline) in the subgroups where the «school» was held. Financial costs during the 12-month follow-up period for patients decreased by seven times because most patients stopped taking medications to relieve headaches.

Conclusion. Information and educational programs are an integral part of the management of patients with MOH.

About the Authors

A. E. Shagbazyan
N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Department of Nervous System Diseases and Neurosurgery

11, Rossolimo St., Build. 1, Moscow 119021

N. A. Kovalchuk
N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Department of Nervous System Diseases and Neurosurgery

11, Rossolimo St., Build. 1, Moscow 119021

G. R. Tabeeva
N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Gyuzyal Rafkatovna Tabeeva

Department of Nervous System Diseases and Neurosurgery

11, Rossolimo St., Build. 1, Moscow 119021


1. Buse DC, Manack AN, Fanning K. Chronic migraine prevalence, disability and sociodemographic factors: results from the American Migraine Prevalence and Prevention Study. Headache. Nov-Dec 2012;52(10):1456- 70. doi: 10.1111/j.1526-4610.2012.02223.x. Epub 2012 Jul 25.

2. Natoli JL, Manack A, Lipton RB, et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010 May;30(5):599-609. doi: 10.1111/j.1468-2982.2009.01941.x

3. Schwartz BS, Stewart WF, Simon D, Lipton RB. Epidemiology of tension-type headache. JAMA. 1998 Feb 4;279(5):381-3. doi: 10.1001/jama.279.5.381

4. Lu SR, Fuh JL, Chen WT, et al. Chronic daily headache in Taipei, Taiwan: prevalence, follow-up and outcome predictors. Cephalalgia. 2001 Dec;21(10):980-6. doi: 10.1046/j.1468-2982.2001.00294.x

5. Global, regional and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study. Lancet Neurol. 2017 Nov;16(11):877-97. doi: 10.1016/S1474- 4422(17)30299-5. Epub 2017 Sep 17.

6. Louter MA, Robbins MS, Terwindt GM. Medication overuse headache: an ongoing debate. Neurology. 2017 Sep 19;89(12):1206-7. doi: 10.1212/WNL.0000000000004374. Epub 2017 Aug 18.

7. Radat F, Creac'h C, Guegan-Massardier E, et al. Behavioral dependence in patients with medication overuse headache: a crosssectional study in consulting patients using the DSM-IV criteria. Headache. 2008 Jul;48(7):1026-36. doi: 10.1111/j.1526-4610.2007.00999.x. Epub 2007 Dec 11.

8. Bahra A, Walsh M, Menon S, Goadsby PJ. Does chronic daily headache arise de novo in association with regular use of analgesics. Headache. 2003 Mar;43(3):179-90. doi: 10.1046/j.1526-4610.2003.03041.x

9. Martins SS, Gorelick DA. Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. population. Drug Alcohol Depend. 2011;119:28-36.

10. Radat F, Creac'h C, Swendsen JD, et al. Psychiatric comorbidity in the evolution from migraine to medication overuse headache. Cephalalgia. 2005 Jul;25(7):519-22. doi: 10.1111/j.1468-2982.2005.00910.x

11. Vandenbussche N, Laterza D, Lisicki M, et al. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain. 2018 Jul 13;19(1):50. doi: 10.1186/s10194-018-0875-x

12. Patel S, Achana F, Carnes D, et al. Usual care and a self-management support programme versus usual care and a relaxation programme for people living with chronic headache disorders: a randomised controlled trial protocol (CHESS). BMJ Open. 2020 Apr 12;10(4):e033520. doi: 10.1136/bmjopen-2019-033520

13. Probyn K, Bowers H, Mistry D, et al. Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review including analysis of intervention components. BMJ Open. 2017 Aug 11;7(8):e016670. doi: 10.1136/bmjopen2017-016670

14. Robblee J, Starling AJ. SEEDS for success: Lifestyle management in migraine. Cleveland Clin J Med. 2019 Nov;86(11):741-9. doi: 10.3949/ccjm.86a.19009

15. Faizi F, Tavallaee A, Rahimi A, Saghafinia M. Management of Chronic Daily Headache and Psychiatric Co-Morbidities by Lifestyle Modification: Participatory Action Research Combining New Communication Media. Anesth Pain Med. 2017 Jan 23;7(2):e42782. doi: 10.5812/aapm.42782. eCollection 2017 Apr.

16. Lee HJ, Lee JH, Cho EY, et al. Efficacy of psychological treatment for headache disorder: a systematic review and meta-analysis. J Headache Pain. 2019 Feb 14;20(1):17. doi: 10.1186/s10194-019-0965-4

17. Rossi P, Faroni JV, Tassorelli C, Nappi G. Advice alone versus structured detoxification programmes for complicated medication overuse headache (MOH): a prospective, randomized, open-label trial. J Headache Pain. 2013 Feb 8;14(1):10. doi: 10.1186/1129-2377-14-10

18. Goffau MJ, Klaver AR, Willemsen MG, et al. The effectiveness of treatments for patients with medication overuse headache: a systematic review and meta-analysis. Pain. 2017 Jun;18(6):615-27. doi: 10.1016/j.jpain.2016.12.005. Epub 2016 Dec 20.

19. Krause SJ, Stillman MJ, Tepper DE, Zajac D. A prospective cohort study of outpatient interdisciplinary rehabilitation of chronic headache patients. Headache. 2017 Mar;57(3):428-40. doi: 10.1111/head.13020. Epub 2017 Jan 27.

20. Mose LS, Pedersen S, Debrabant B, et al. The role of personality, disability and physical activity in the development of medication-overuse headache: a prospective observational study. J Headache Pain. 2018 May 25;19(1):39. doi: 10.1186/s10194-018-0863-1

21. Costa PT Jr, McCrae RR. Domains and facets: hierarchical personality assessment using the revised NEO personality inventory. J Pers Assess. 1995 Feb;64(1):21-50. doi: 10.1207/s15327752jpa6401_2

22. Bigal ME, Sheftell FD, Rapoport AM, et al. MMPI personality profiles in patients with primary chronic daily headache: a casecontrol study. Neurol Sci. 2003 Oct;24(3):103- 10. doi: 10.1007/s10072-003-0094-2

23. Hagen K, Linde M, Steiner TJ, et al. Risk factors for medication-overuse headache: an 11- year follow-up study. The Nord-Trondelag Health Studies. Pain. 2012 Jan;153(1):56-61. doi: 10.1016/j.pain.2011.08.018. Epub 2011 Oct 22.

24. Westergaard ML, Glumer C, Hansen EH, Jensen RH. Medication overuse, healthy lifestyle behaviour and stress in chronic headache: Results from a population-based representative survey. Cephalalgia. 2016 Jan;36(1):15-28. doi: 10.1177/0333102415578430. Epub 2015 Mar 24.

25. Narin SO, Pinar L, Erbas D, et al. The effects of exercise and exercise-related changes in blood nitric oxide level on migraine headache. Clin Rehabil. 2003 Sep;17(6):624-30. doi: 10.1191/0269215503cr657oa

26. Fritsche G, Frettloh J, Huppe M, et al. Prevention of medication overuse in patients with migraine. Pain. 2010 Nov;151(2):404-13. doi: 10.1016/j.pain.2010.07.032. Epub 2010 Aug 30.

27. Diener HC, Holle D, Dresler T, Gaul C. Chronic headache due to overuse of analgesics and anti-migraine agents. J Dtsch Arztebl Int. 2018 Jun 1;115(22):365-70. doi: 10.3238/arztebl.2018.0365

28. Diener HC, Dodick D, Evers S, et al. Pathophysiology, prevention, and treatment of medication overuse headache. Lancet Neurol. 2019 Sep;18(9):891-902. doi: 10.1016/S1474-4422(19)30146-2. Epub 2019 Jun 4.


For citations:

Shagbazyan A.E., Kovalchuk N.A., Tabeeva G.R. Role of educational programs in management of patients with medication-overuse headache. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(3):27-33.

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)