Polypharmacy Among Headache Patients: A Cross-Sectional Study

CNS Drugs https://doi.org/10.1007/s40263-018-0522-8 ORIGINAL RESEARCH ARTICLE Polypharmacy Among Headache Patients: A Cross-Sectional Study Anna Ferrari1 • Carlo Baraldi2 • Manuela Licata3 • Cecilia Rustichelli4 Ó The Author(s) 2018 Abstract Background Polypharmacy can appropriately treat multiple chronic conditions, but it can also increase potential harm. Polypharmacy information for primary headaches is minimal, despite drugs being the main tools to manage headaches. Objective The aim was to evaluate the prevalence, characteristics and risk factors of polypharmacy in patients with Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40263-018-0522-8) contains supplementary material, which is available to authorized users. & Anna Ferrari Carlo Baraldi Manuela Licata Cecilia Rustichelli 1 Unit of Medical Toxicology, Department of Diagnostic, Clinical and Public Health Medicine, Headache and Drug Abuse Centre, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy 2 School of Medical Toxicology, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41124 Modena, Italy 3 Forensic Toxicology Laboratory, Department of Diagnostic Medicine, Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena, Italy 4 Department of Life Sciences, University of Modena and Reggio Emilia, via G. Campi, 103, 41125 Modena, Italy primary headaches and examine whether these variables differ between episodic and chronic headache patients. Methods We analysed polypharmacy (simultaneous use of five or more medications), medication type, comorbidity, and risk factors in 300 patients (mean age 42.81 ± 13.21 years) with primary headaches, divided into episodic and chronic, afferent to a headache centre. Results Patients took an average of 4.37 medications. Polypharmacy was common in 40.7% of patients, and among chronic patients, it reached 58.8%. Most patients used medications (mainly nonsteroidal anti-inflammatory drugs; 73.5%) to treat acute headaches, and 30.4% of episodic and 64.7% of chronic sufferers underwent prophylactic treatment (P \ 0.0001), mostly using antidepressants (77.3%). Up to 76.7% of the cohort was taking other medications, primarily for acid-related disorders (21.7%). Comorbidities were present in 59.7% of the cohort. Variables significantly associated with polypharmacy were comorbidities, prophylactic treatment, and triptans (P \ 0.001). Conclusions Patients with primary headaches, mainly young adults, are exposed to high polypharmacy, comparable to that of the elderly. Because increased numbers of drugs increase the risk of adverse reactions, the many medications concomitantly taken by primary headache sufferers should be frequently reviewed. A. Ferrari et al. Key Points Among young adult patients with primary headaches, especially chronic headaches, polypharmacy is common and comparable to that found among the elderly. Most polypharmacy is due to prescription drugs that patients take to treat their headaches and only to a lesser extent to those used to treat other comorbidities. These results suggest that medications should be reviewed regularly in primary headache patients, and to avoid risks, discontinuing ineffective or harmful medications may be necessary. 1 Introduction Polypharmacy is defined as the use of multiple medications by an individual patient [1]. This can be appropriate, or even necessary, when no alternatives exist for treating several comorbidities for which different drugs are required and helpful [2]. Nevertheless, concern is growing regarding the risks and complications of polypharmacy [3]. Increases in the number of concomitant medications increases the risk of adverse reactions, which can increase than that of individual drugs. Polypharmacy can also decrease treatment adherence [3, 4] and cause suboptimal health outcomes, wasted medications and a lower quality of life [1, 5, 6]. Polypharmacy has been extensively studied and reported to be prevalent and increasing among the elderly, because of the many subjects with multimorbidities that require multiple medications [4, 7–9]. The prevalence of and complications related to polypharmacy have been evaluated in patients with cancer pain and chronic non-malignant pain [5, 10]; however, few data [11, 12] exist on this issue for primary headaches, despite these disorders being exposed to the possibility of polypharmacy. Primary headaches are widespread in the general population and prevalent in females [13]. They occur in three main forms: migraine, whose 1-year prevalence is 15% in the general population; tension-type headache, the most prevalent headache, affecting 60% of the adult population; and cluster headache, the least frequent type, occurring in less than 1% of the population [13]. They often remain episodic and improve over time, but may worsen and become chronic and disabling and negatively impact the sufferers’ quality of life [14]. Moreover, they are often associated with other medical and psychiatric conditions [15] that require additional pharmacological treatments. The pathophysiology of primary headaches remains incompletely understood, and no causal and definitive therapies are actually available for these disorders, despite the recent progress in this field [13, 16]. Headache management is mainly based on pharmacological treatments comprising drugs for acute treatment, such as nonsteroidal anti-inflammatory drugs (NSAIDs), triptans, analgesics, muscle relaxants and anti-nausea drugs, and preventive drugs, such as antidepressants, antiepileptics, beta-blocking agents, calcium channel blockers, serotonin antagonists [16] and onabotulinumtoxinA [17]. Acute treatment is always prescribed to headache patients, whereas preventive treatment is recommended in the case of frequent, severe and long-lasting attacks, when symptomatic medications induce only limited effects or are contraindicated, or if the patient’s quality of life is seriously affected. Preventive treatment is directed to specifically decrease the frequency of headache attacks and should be taken usually from 3 to 6 months. During the treatment, the patients must often continue taking acute medications for the attack and may need other medications for associated or new-onset illnesses [16]. The objectives of the present study were as follows: (1) to evaluate the prevalence, characteristics and risk factors of polypharmacy, drug utilization and comorbidities in patients with primary headaches afferent to a headache centre; (2) to analyse whether these variables differ between episodic and chronic headache sufferers. 2 Methods 2.1 Study Design and Study Sample This cross-sectional, observational study evaluated all drugs regularly taken by 300 primary headache patients consecutively afferent to a headache centre. Patients under 18 years old and suffering from secondar (...truncated)