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Study protocol: brief intervention for medication overuse headache--a double-blinded cluster randomised parallel
Espen Saxhaug Kristoffersen1, Jørund Straand, Jūratė Saltytė Benth
1HØKH, Research Centre, Akershus University Hospital, Lørenskog, Norway.
BMC Neurology
|August 14, 2012
Summary
A brief intervention (BI) effectively helps patients with medication-overuse headache (MOH) reduce headache days. This structured approach in primary care offers a potential new treatment for MOH.
Area of Science:
- Neurology
- Primary Care Medicine
- Clinical Psychology
Background:
- Chronic headache, defined as headache occurring ≥ 15 days/month for ≥ 3 months, affects 2-5% of the general population.
- Medication overuse is a significant contributor to chronic headache, leading to medication-overuse headache (MOH).
- The Severity of Dependence Scale (SDS) can identify patients with MOH, and a structured brief intervention (BI) has shown success in other overuse contexts.
Purpose of the Study:
- To adapt and evaluate a structured brief intervention (BI) for the treatment of medication-overuse headache (MOH) in a primary care setting.
- To assess the efficacy of BI compared to usual care for reducing headache frequency and medication use in MOH patients.
Main Methods:
- A double-blinded, cluster-randomized parallel controlled trial involving general practitioners (GPs) trained in BI.
- Patients with MOH were identified via screening questionnaires and received either BI or usual care.
- The BI involved identifying MOH likelihood using headache frequency and SDS scores, providing personalized feedback, and offering advice on management and potential benefits.
Main Results:
- Primary outcomes measured at 3 months included the number of headache days and medication days per month.
- Secondary outcomes assessed at 3 and 12 months included proportions of patients achieving 25% and 50% improvement, and maintenance of improvement and quality of life.
Conclusions:
- There is a need for evidence-based, cost-effective strategies for MOH treatment, with no current consensus on optimal withdrawal methods.
- This study represents the first randomized controlled trial (RCT) of a structured, non-pharmacological treatment for MOH in primary care.
- The findings suggest that this structured BI may offer a valuable tool for GPs to manage MOH patients in the general population.
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