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Definitions of medication-overuse headache in population-based studies and their implications on prevalence
Maria L Westergaard1, Ebba Holme Hansen, Charlotte Glümer
1Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.
Background:
Case definitions of medication-overuse headache (MOH) in population-based research have changed over time. This study aims to review MOH prevalence reports with respect to these changes, and to propose a practical case definition for future studies based on the ICHD-3 beta.
Methods:
A systematic literature search was conducted to identify MOH prevalence studies. Findings were summarized according to diagnostic criteria.
Results:
Twenty-seven studies were included. The commonly used case definition for MOH was headache ≥15 days/month with concurrent medication overuse ≥3 months. There were varying definitions for what was considered as overuse. Studies that all used ICHD-2 criteria showed a wide range of prevalence among adults: 0.5%-7.2%.
Conclusions:
There are limits to comparing prevalence of MOH across studies and over time. The wide range of reported prevalence might not only be due to changing criteria, but also the diversity of countries now publishing data. The criterion "headache occurring on ≥15 days per month" with concurrent medication overuse can be applied in population-based studies. However, the new requirement that a respondent must have "a preexisting headache disorder" has not been previously validated. Exclusion of other headache diagnoses by expert evaluation and ancillary examinations is not feasible in large population-based studies.
Insights
Medication-overuse headache (MOH) prevalence varies widely due to changing diagnostic criteria. A practical definition for future population studies is proposed, focusing on headache frequency and medication use.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Medication-overuse headache (MOH) case definitions have evolved, impacting prevalence research.
- Previous studies utilized varying criteria, leading to inconsistent findings.
Purpose of the Study:
- To review MOH prevalence reports considering changes in diagnostic criteria.
- To propose a practical case definition for future population-based studies using the ICHD-3 beta guidelines.
Main Methods:
- A systematic literature search identified studies on MOH prevalence.
- Findings were analyzed and summarized based on the diagnostic criteria employed.
Main Results:
- Twenty-seven studies were included in the review.
- A common definition involved headache ≥15 days/month with medication overuse for ≥3 months.
- Prevalence estimates using ICHD-2 criteria ranged from 0.5% to 7.2% in adults.
Conclusions:
- Comparing MOH prevalence across studies and time is challenging due to evolving criteria and diverse geographical data.
- The criterion of headache on ≥15 days/month with medication overuse is applicable for population studies.
- The ICHD-3 beta requirement for a preexisting headache disorder needs validation for large-scale research.
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