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The heterogeneity of headache patients who self-medicate

a cluster analysis approach

Mehuys, Elsa,*; Paemeleire, Koenb; Crombez, Geertc; Adriaens, Elsa; Van Hees, Thierryd; Demarche, Sophied; Christiaens, Thierrye; Van Bortel, Lucf; Van Tongelen, Ingea; Remon, Jean-Paula; Boussery, Koena

doi: 10.1097/j.pain.0000000000000541
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Patients with headache often self-treat their condition with over-the-counter analgesics. However, overuse of analgesics can cause medication-overuse headache. The present study aimed to identify subgroups of individuals with headache who self-medicate, as this could be helpful to tailor intervention strategies for prevention of medication-overuse headache. Patients (n = 1021) were recruited from 202 community pharmacies and completed a self-administered questionnaire. A hierarchical cluster analysis was used to group patients as a function of sociodemographics, pain, disability, and medication use for pain. Three patient clusters were identified. Cluster 1 (n = 498, 48.8%) consisted of relatively young individuals, and most of them suffered from migraine. They reported the least number of other pain complaints and the lowest prevalence of medication overuse (MO; 16%). Cluster 2 (n = 301, 29.5%) included older persons with mainly non-migraine headache, a low disability, and on average pain in 2 other locations. Prevalence of MO was 40%. Cluster 3 (n = 222, 21.7%) mostly consisted of patients with migraine who also report pain in many other locations. These patients reported a high disability and a severe limitation of activities. They also showed the highest rates of MO (73%).

Individuals with headache who self-medicate form a rather heterogenous group. Cluster analysis identified 3 subtypes exhibiting marked differences in prevalence of medication overuse.

aPharmaceutical Care Unit, Ghent University, Ghent, Belgium

bDepartment of Neurology, Ghent University Hospital, Ghent, Belgium

cDepartment of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium

dCIRM, Clinical Pharmacy Unit, University of Liege, Liege, Belgium

eDepartment of Family Medicine and Primary Health Care and Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium

fHeymans Institute of Pharmacology, Ghent University, Ghent, Belgium

Corresponding author. Address: Pharmaceutical Care Unit, Ghent University, Harelbekestraat 72, B-9000 Ghent, Belgium. Tel.: +32 92648043; fax: +32 92228236. E-mail address: els.mehuys@ugent.be (E. Mehuys).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received September 02, 2015

Received in revised form January 08, 2016

Accepted February 09, 2016

© 2016 International Association for the Study of Pain
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