Feasibility of a brief intervention for medication-overuse headache in primary care – a pilot study
BMC Research Notes
Feasibility of a brief intervention for medication- overuse headache in primary care - a pilot study
Espen Saxhaug Kristoffersen 0 1
Jørund Straand 1
Michael Bjørn Russell 2 4
Christofer Lundqvist 0 3 4
0 Health Service Research Centre, Research Centre, Akershus University Hospital , PO Box 95, 1478 Lørenskog , Norway
1 Department of General Practice, Institute of Health and Society, University of Oslo , Blindern, PO Box 1130, 0318 Oslo , Norway
2 Head and Neck Research Group, Research Centre, Akershus University Hospital , PO Box 95, 1478 Lørenskog , Norway
3 Department of Neurology, Akershus University Hospital , Nordbyhagen , Norway
4 Institute of Clinical Medicine, Akershus University Hospital, University of Oslo , Nordbyhagen , Norway
Background: Medication-overuse headache (MOH) is a common problem in primary care. Brief intervention (BI) has successfully been used for detoxification from overuse of alcohol and drugs. The aim of this pilot study was to develop and test methodology, acceptability and logistics for a BI for MOH in primary care. Findings: Observational feasibility study of an intervention in a Norwegian general practice population. Six general practitioners (GPs) were recruited. A screening questionnaire for MOH was sent to all 18-50 year old patients on these GPs` list. GPs were taught BI, which was applied to MOH patients as follows: Severity of dependence scale (SDS) scores were collected and individual feedback was given of the relationship between the SDS, medication overuse and headache. Finally, advice to reduce medication was given. Patients were invited to a headache interview three months after the BI. Main outcomes were feedback from GPs/patients about the feasibility and logistics of the study design, screening/recruitment process, BI and headache interviews. Efficacy and patient-related outcomes were not focused. The patients reported a high degree of acceptability of the methodology. The GPs reported the BI to be feasible to implement within a busy practice and to represent a new and improved instrument for communication with MOH patients. The BI requires further testing in a randomised controlled trial (RCT) in order to provide evidence of efficacy. Conclusion: This feasibility study will be used to improve the BI for MOH and the design of a cluster-RCT. Trial registration: ClinicalTrials.gov: NCT01078012 (Initially registered as controlled efficacy trial but changed to observational study).
Chronic headache; Medication-overuse headache; Migraine; Brief intervention; General practice; Severity of dependence scale; Feasibility study; Pilot study
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Findings
Background
Headache is a frequent symptom in primary care
attendees, accounting for 4% of the consultations in the
UK [
1
]. Headache prescription medications only partly
account for the total medication use for headache since
most patients buy over-the-counter (OTC) drugs [
2-4
].
Between two and five percent of the world’s population
report chronic headache [
5-7
], and approximately 75%
have been in contact with their GP [
2,3
].
Medicationoveruse headache (MOH) is a major cause of chronic
headache with prevalence in the general population of
1–1.5% [
4,6,8-10
], and is probably the most costly
headache disorder [11]. By definition, MOH is chronic
headache (≥15 days/month) with frequent medication use
(Table 1) [
12-15
].
There is no consensus on the management of MOH
and an obvious need for evidence-based and cost-effective
management strategies [
10,16,17
]. However, detoxification
is generally accepted as the avenue to employ [
18
], since
withdrawal of the overused medication(s) leads to an
improvement of the headache, after an initial worsening for
1–2 weeks [
17,19
].
MOH has been suggested to include subgroups of
both simple and complex cases, where some of the latter
may show “dependency-like” behaviour [
20-24
].
Previous studies from our group have revealed that the
Severity of Dependence Scale (SDS) [
25
] can detect
B. Regular overuse for >3 months of one or more drugs that can be
taken for acute and/or symptomatic treatment of headache
C. Headache has developed or markedly worsened during medication
overuse
For simple analgesics and for combination of acute medications the intake must
be 15 days or more per month, for triptans, ergotamins, opioids and combination
analgesics,10 days per month is enough to get the diagnosis of MOH.
MOH among subjects with chronic headache in a
general population [
26,27
].
Brief Intervention (BI) is a well-known approach to
identify and treat unhealthy alcohol use [
28
]. BI involves
the use of an identification tool followed by feedback to
the identified individual as being “at risk”. The final step
is to give information suggesting cutting down the use
of the particular substance to predefined “acceptable”
levels [
28
]. In primary care settings, there is now
substantial evidence of the benefits and cost-effectiven (...truncated)