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Disability in Chronic Migraine Patients with
Medication Overuse: Treatment Effects at 1-Year Follow-up
Grazzi L, Andrasik F, D’Amico D, et al.
Posted: October 2004
Headache 2004;44:678-683
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Objective: To determine (1) the
clinical course of a sample of chronic migraine patients with
drug overuse 6 and 12 months following in-patient treatment,
and (2) whether functional impairment, assessed by the Migraine
Disability Assessment (MIDAS) questionnaire, improved upon
treatment.
Background: Patients with chronic migraine and
medication overuse are particularly difficult to treat
(prophylactic medications that otherwise are effective
become ineffective; discontinuation of the offending medication
can lead to withdrawal headache; physical and emotional
dependence can be present, as well as increased psychological
involvement; initial treatment gains can be difficult to
maintain).
Methods: Of the 106 patients meeting criteria
for chronic migraine with medication overuse, 84 went on to
complete a structured in-patient treatment, consisting of
medication withdrawal and then prophylactic treatment.
Results: As a group, the patients were improved
at both 6- and 12-month follow-up, with respect to two headache
parameters (frequency and medication use) and three measures of
functional impact extracted from the MIDAS questionnaire (Total
Score, Headache Frequency, and Headache Intensity).
Conclusion: Chronic migraine accompanied with
medication overuse led to the considerable disability prior to
treatment. However, notable improvement occurred coincident
with the 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 prospectively as
an outcome measure in patients with chronic migraine and
medication overuse to assess disability, subsequent to a
semi-standardized treatment program.
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