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Does medication overuse headache represent a behavior of dependence?

Jong-Ling Fuh1, Shuu-Jiun Wang, Shiang-Ru Lu

  • 1The Neurological Institute, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan Department of Psychiatry, Buddhist Tzu Chi General Hospital, Taipei and Tzu Chi University School of Medicine, Hualian, Taiwan.

Pain
|November 22, 2005
PubMed
Summary

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Patients with probable medication overuse headache (pMOH) are significantly more likely to meet criteria for substance dependence. Factors like migraine, frequent doctor visits, and anxiety influence this association in chronic daily headache sufferers.

Area of Science:

  • Neurology
  • Psychiatry
  • Clinical Medicine

Background:

  • Medication overuse is a frequent issue in individuals experiencing headaches.
  • Understanding substance dependence prevalence and associated factors in chronic headache patients is crucial for effective management.

Purpose of the Study:

  • To determine the prevalence of substance dependence criteria (DSM-IV) in chronic daily headache patients.
  • To identify variables associated with substance dependence among these patients.

Main Methods:

  • Recruited 1,861 chronic daily headache patients (Nov 1999 - June 2004).
  • Utilized headache intake forms, a DSM-IV modified dependence questionnaire, and the Hospital Anxiety and Depression Scale (HADS).
  • Defined probable medication overuse headache (pMOH) using the International Classification of Headache Disorders, 2nd edition criteria.

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Main Results:

  • 48% of patients met criteria for pMOH.
  • 68% of pMOH patients met DSM-IV substance dependence criteria, compared to 20% of non-pMOH patients (OR=8.6).
  • Substance dependence was linked to more physician appointments, migraine, headache intensity, and higher anxiety scores.

Conclusions:

  • Probable medication overuse headache is strongly associated with substance dependence behaviors in chronic daily headache patients.
  • Migraine, frequent healthcare utilization, headache severity, and anxiety are significant predictors of substance dependence.