Chronic Migraine with Medication Overuse: Clinical Pattern and Evolution from a Retrospective Cohort in Seville, Spain

DOI: https://doi.org/10.1007/s42399- 020- 00424- 8

Abstract-Summary Chronic migraine (CM) with medication overuse (MO) develops in patients with a pre-existing primary headache after a regular overuse of symptomatic medication.

A cohort of 102 patients (89 women and 13 men) with a diagnosis of chronic

migraine (CM) with medication overuse (MO) was retrospectively analysed.

3.5 Medication Overuse and Addiction

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We observed that most of the patients overused multiple symptomatic drugs

(34.3%) and NSAIDs (26.5%).

We observed the ratio of patients reducing their headache crisis was significantly

higher among patients abandoning their medication overuse.

Detoxification, or withdrawal of medication overuse, is linked to the reduction of the frequency and intensity of 50% or more of the headache crisis in these patients. Extended: Chronic migraine (CM) with medication overuse (MO) is the most

prevalent chronic headache disorder [551].

Introduction Chronic migraine (CM) with medication overuse (MO) is the most prevalent chronic headache disorder [551].

According to the International Classification of Headache Disorders, chronic migraine (CM) with medication overuse (MO) is defined as a headache occurring on 15 or more days/month in a patient with a pre-existing headache disorder with a regular medication overuse for more than three months that does not better account for any other diagnosis [552].

A history of primary headache is a necessary condition to develop CM with MO as analgesics overuse alone has not been related to this chronic headache condition. Abuse of analgesics in patients with musculoskeletal pain or rheumatologic pro- cesses does not lead to a higher prevalence of CM with MO [553], but these patients may develop CM with MO if they also have a primary headache.

CM with MO is a condition that worsens with symptomatic medication overuse,

and so headaches become increasingly frequent [554, 555].

Materials and Methods The inclusion criteria of this study were to have been diagnosed with CM with MO according to the beta version of the third edition of the International Classification of Headache Disorders (ICHD) [16] and to have been actively followed up in the Neurology Service of the University Hospital Virgen del Rocío in Seville and seen patients with information on variables of interest for this study.

Epidemiological and clinical data of clinical records are analysed and collected in two checkings: The first medical review at 4 months (mean value) of the diagno- sis is checked.

This is the last review of each patient in his medical history, either because he is discharged well because he is still being followed up but has no further reviews at the time of our study.

It is important to know the data that inform us of the evolution of the patient

throughout his follow-up.

Results A drug treatment is considered effective when the patient reduces his headache crisis by 50% or more.

After the first checking, 28.4% of the patients reduced their crisis 50% or more. When treatment effectiveness was analysed, topiramate yielded the best results as 7 out the 13 patients under topiramate treatment reduced their crisis 50% or more (53.8% effectiveness).

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3 Diagnosis

Propranolol and the combination of prophylactic drugs had also good effective- ness in the first checking, as 40% and 36.1% of the patients under propranolol and the combination of prophylactic drugs respectively reduced their crisis.

We observed an increase in the reduction of 50% or more of the crisis in the last

checking, when 51.1% of the patients had reduced their crisis.

Patients experimenting a reduction of their crisis had a significantly lower head-

ache evolution time in the last checking with a p value below 0.023.

Discussion In these studies, a greater reduction in the rate of headaches was seen in patients who received prophylactic medication from the beginning.

It is important that the patients abandon overuse medication, and it is recom-

mended that they receive 2–3 prophylactic treatments before OBT-A treatment.

Our study shows results that lead us to believe that CM with MO is a disease that appears in patients with a history of primary headache (migraine in this case) of years of evolution, and that it presents clinical features different to primary head- ache (it would be a “transformation” of the primary headache).

It is important to highlight that the vast majority of patients with CM with MO

have a medical history of medication overuse for years.

They based their idea on studies of patients with chronic migraine treated with onabotulinumtoxinA. These patients, mostly with a co-diagnosis of MOH, reduced their medication intake and improved their headache [556].

Acknowledgement A machine generated summary based on the work of López Martínez, María del Valle; Pareja Román, Javier; Jiménez Hernández, María Dolores; Maestu Unturbe, Ceferino; Ramírez-Castillejo, María del Carmen. 2020  in SN Comprehensive Clinical Medicine.

Psychoactive substances as a last resort—a qualitative study of self-treatment of migraine and cluster headaches