Chronic migraine with medication overuse: treatment outcome and disability at 3 years follow-up.
ABSTRACT Patients with chronic migraine and medication overuse are particularly difficult to treat. No clear consensus exists about treatment strategies to be used and little data exists about the functional impact of headache in these patients. The purpose of the study was to determine (1) the clinical course of a sample of chronic migraine patients with medication overuse 36 months following treatment intervention and (2) whether functional impairment, assessed by the Migraine Disability Assessment (MIDAS) questionnaire, improved upon treatment. Of 106 patients meeting the criteria for chronic migraine with medication overuse (according to Silberstein and Lipton), 71 went on to complete a structured inpatient treatment, consisting of medication withdrawal and then prophylactic treatment. As a group, the patients were significantly improved at 36-month follow-up, with respect to 2 headache parameters (days of headache per month and number of used medications per month assessed by the diary card) and 2 measures of functional impact extracted from the MIDAS questionnaire (MIDAS total score and frequency of headache). Chronic migraine accompanied with medication overuse led to considerable disability prior to treatment. However, notable improvement both in headache parameters and in disability measures occurred concurrently with treatment. This suggests that successful treatment has more wide-ranging positive benefits beyond mere symptom reduction. To our knowledge, this is the first investigation where the MIDAS questionnaire has been used as an outcome measure in patients with chronic headache to assess disability during such a long follow-up period.
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ABSTRACT: We present a prospective study of 240 patients with medication overuse headache (MOH) treated with drug withdrawal and prophylactic medications. At 1-year follow-up, 137 (57.1%) patients were without chronic headache and without medication overuse, eight (3.3%) patients did not improve after withdrawal and 95 (39.6%) relapsed developing recurrent overuse. Age at time of MOH diagnosis, regular use of benzodiazepines, frequency and Migraine Disability Assessment (MIDAS) score of chronic headache, age at onset of primary headache, frequency and MIDAS score of primary headache, ergotamine compound overuse and daily drug intake were significantly different between successfully and unsuccessfully treated patients. Multivariate analysis determined the frequency of primary headache disorder, ergotamine overuse and disability of chronic headache estimated by MIDAS as independent predictors of treatment efficacy at 1-year follow-up.Cephalalgia 12/2007; 27(11):1219-25. · 3.49 Impact Factor
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ABSTRACT: The Short Form-36 (SF-36) and Migraine Disability Assessment (MIDAS) questionnaires are two of the most commonly used tools to measure outcomes in people suffering from headaches. Nevertheless, little is known about their interrelationship in patients with headache. The aim of this study was to investigate the interrelationship between SF-36 and MIDAS questionnaires in patients with migraine. We enrolled 231 patients with migraine (male/female: 43/188, mean age 35.3+/-8.1) who visited our headache clinic. They completed the SF-36, MIDAS, and a headache intake form. The correlation coefficients between the MIDAS score and 8 domains of the SF-36 ranged from -0.30 for the mental health domain to -0.53 for the social functioning domain (P<0.01). Canonical correlation analysis showed that the overall overlap between the 2 instruments was moderately strong (canonical correlation coefficients r=0.707 and 0.572). The overall measured redundancies for MIDAS and SF-36 scales in this study were 35.4% and 11.5%, respectively. The stepwise linear regression model showed that the social functioning domain alone explained 27.9% of variance in the MIDAS scores. Bodily pain, physical functioning, and general health domains added an additional 11.4% of the explained variance in the regression model. Despite the fact that these two measures were considerably correlated, the MIDAS and SF-36 were found to measure different aspects of the impact of headache for the sample investigated. The MIDAS questionnaire does not cover the emotional domain; therefore, an accompanying psychological questionnaire might help assess the outcome for headache studies.Clinical Journal of Pain 01/2006; 22(6):564-8. · 2.55 Impact Factor
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ABSTRACT: Integrated care builds interdisciplinary networks across the different healthcare sectors. A conjoint effort toward clearly defined treatment goals is crucial for medically effective and economically efficient care. Allowing creativity in the implementation of integrated care triggers competition for more effective ideas and better solutions. Based on a summary of the development of integrated care and the example of the nationwide German headache treatment network, the successful organization and implementation of this cross-sectoral care within pain medicine is illustrated. An interdisciplinary nationwide network of pain therapists working hand in hand across the sectors, both in the outpatient and inpatient setting, and employing modern treatment regimens results in optimal pain relief. The treatment quality is assessed by continuous accompanying research and sustainable cost efficiency in all sectors of healthcare is confirmed through analysis of both direct and indirect costs. The project was started in May 2007. In the meantime, almost all large statutory health insurance providers in Germany have joined this healthcare project. The large treatment network confirms the significant clinical and economic efficiency of pain medicine. It demonstrates that coordinated modern therapy effectively relieves pain, lowers costs sustainably, and reduces sick leave. Patient satisfaction is very high. The healthcare providers may directly participate in treatment success through risk-sharing.Der Schmerz 11/2009; 23(6):653-70. · 1.02 Impact Factor