Articles

Prevention of medication overuse in patients with migraine

Fritsche, Günther^a,*; Frettlöh, Jule^c; Hüppe, Michael^d; Dlugaj, Martha^a; Matatko, Nadine^a; Gaul, Charly^a,b; Diener, Hans-Christoph^a on Behalf of the Study Group

Author Information

^aDepartment of Neurology and Headache Center, University Hospital Essen, Germany

^bDepartment of Neurology, University Hospital Halle, Germany

^cDepartment of Pain Management, BG-Klinikum Bergmannsheil, University Hospital Bochum, Germany

^dDepartment of Anaesthesiology, University of Luebeck, Germany

^*Corresponding author. Tel.: +49 201 723 3263; fax: +49 201 723 5939.

E-mail address:[email protected]

Submitted August 17, 2009; revised July 14, 2010; accepted July 29, 2010.

Pain 151(2):p 404-413, November 2010. | DOI: 10.1016/j.pain.2010.07.032

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Abstract

This multi-center study compared the therapeutic effect of a cognitive-behavioral minimal contact program (MCT) to the effect of a brochure (bibliotherapy) for the prevention of medication overuse headache (MOH) in migraine patients. Seven German headache centers recruited 182 migraine patients with high triptan or analgesic intake frequency. Patients were randomly allocated to either the MCT-group, receiving both an MCT program and an educational brochure or to the biblio-group receiving only the brochure. All participants continued usual medical treatment. Course of headaches, intake of analgesics or triptans after training, 3 months post-training as well as 1–2 years (mean 15.7 months) later and psychological variables were defined as outcome variables. A significant decline was observed in the number of headache days (11.0–8.8), migraine days (7.3–5.7) and medication intake days (7.4–6.1) from pre to post in the MCT-group (p < 0.001 each) and in the biblio-group (p < 0.001 each). The pre-to-post-improvements were maintained from pre- to short- and from pre- to long-term follow-up (p < 0.001 each) in both groups. Both groups improved significantly from pre to post in psychological variables, e.g. pain acceptance: p < 0.001; pain catastrophizing: p < 0.001; functional pain coping: p < 0.001; and pain related internal control beliefs: p < 0.01. Psychological improvements remained stable in both groups at short- and long-term follow-up. During the study, none of the patients developed an MOH. MCT- and bibliotherapy are useful in migraine patients to prevent medication overuse headache or the transition of episodic to chronic headache.