J Clin Neurol.  2012 Sep;8(3):198-203. 10.3988/jcn.2012.8.3.198.

Differences in Clinical Features and Disability according to the Frequency of Medication Use in Patients with Chronic Migraine

• Suh GI
• Park JW
• Shin HE

• KMID: 2287591
• DOI: http://doi.org/10.3988/jcn.2012.8.3.198

Abstract

BACKGROUND AND PURPOSE
Chronic migraine (CM) has a significant impact on daily activities, and analgesic overuse is a major contributing factor to migraine transformation. Limited information is available on the functional consequences of CM stemming from analgesic overuse. This study evaluated the impact of the frequency of analgesic medication use on headache-related disability and clinical features in patients with CM.
METHODS
Patients with CM were enrolled consecutively and classified into two groups according to their frequency of medication use: <15 days/month (CM-ML, n=52) and > or =15 days/month (CM-MH, n=68). All patients completed a structured questionnaire concerning the clinical features of their migraine, a validated version of the Migraine Disability Assessment questionnaire (MIDAS), and the Headache Impact Test-6 (HIT-6).
RESULTS
The pain intensity, as measured by a visual analog scale, was greater in the CM-MH group than in the CM-ML group (8.5+/-0.2 vs. 7.7+/-0.3, mean+/-SD; p<0.05). In the disability domain, the MIDAS scores were significantly higher for CM-MH patients than for CM-ML patients (47.6+/-4.8 vs. 26.8+/-4.5, p<0.01). The impact from migraine, as measured by the HIT-6, was greater for CM-MH patients than for CM-ML patients (65.6+/-1.0 vs. 62.1+/-1.0, p<0.05).
CONCLUSIONS
Our results indicate that the headache pain intensity and disability are greater in patients with CM who use medication frequently.

Keyword

chronic migraine; disability; HIT-6; medication overuse; MIDAS

MeSH Terms

Headache
Humans
Migraine Disorders
Surveys and Questionnaires

Figure

• 

  Fig. 1 Differences in the MIDAS and HIT-6 grade distributions between the CM-MH and CM-ML groups. The frequency of medication use: <15 days/month (CM-ML) and ≥15 days/month (CM-MH). HIT-6: Headache Impact Test-6, MIDAS: Migraine Disability Assessment questionnaire.

Reference

1. Stovner LJ, Hagen K, Jensen R, Katsarava Z, Lipton R, Scher A, et al. The global burden of headache: a documentation of headache prevalence and disability worldwide. Cephalalgia. 2007. 27:193–210.

2. Lipton RB, Bigal ME, Diamond M, Freitag F, Reed ML, Stewart WF, et al. Migraine prevalence, disease burden, and the need for preventive therapy. Neurology. 2007. 68:343–349.

3. Roh JK, Kim JS, Ahn YO. Epidemiologic and clinical characteristics of migraine and tension-type headache in Korea. Headache. 1998. 38:356–365.

4. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: data from the American Migraine Study II. Headache. 2001. 41:646–657.

5. Castillo J, Muñoz P, Guitera V, Pascual J. Kaplan Award 1998. Epidemiology of chronic daily headache in the general population. Headache. 1999. 39:190–196.

6. Headache Classification Subcommittee of the International Headache Society. The international classification of headache disorders: 2nd edition. Cephalalgia. 2004. 24:Suppl 1. 9–160.

7. Silberstein SD, Olesen J, Bousser MG, Diener HC, Dodick D, First M, et al. The international classification of headache disorders, 2nd edition (ICHD-II)--revision of criteria for 8.2 medication-overuse headache. Cephalalgia. 2005. 25:460–465.

8. Dodick DW. Debate: analgesic overuse is a cause, not consequence, of chronic daily headache. Analgesic overuse is not a cause of chronic daily headache. Headache. 2002. 42:547–554.

9. Tepper SJ. Debate: analgesic overuse is a cause, not consequence, of chronic daily headache. Analgesic overuse is a cause of chronic daily headache. Headache. 2002. 42:543–547.

10. Dodick D, Silberstein S. Central sensitization theory of migraine: clinical implications. Headache. 2006. 46:Suppl 4. S182–S191.

11. Burstein R. Deconstructing migraine headache into peripheral and central sensitization. Pain. 2001. 89:107–110.

12. Bigal ME, Lipton RB. Excessive acute migraine medication use and migraine progression. Neurology. 2008. 71:1821–1828.

13. Starling AJ, Hoffman-Snyder C, Halker RB, Wellik KE, Vargas BB, Dodick DW, et al. Risk of development of medication overuse headache with nonsteroidal anti-inflammatory drug therapy for migraine: a critically appraised topic. Neurologist. 2011. 17:297–299.

14. Monzón MJ, Láinez MJ. Quality of life in migraine and chronic daily headache patients. Cephalalgia. 1998. 18:638–643.

15. Meletiche DM, Lofland JH, Young WB. Quality-of-life differences between patients with episodic and transformed migraine. Headache. 2001. 41:573–578.

16. Bigal ME, Rapoport AM, Lipton RB, Tepper SJ, Sheftell FD. Assessment of migraine disability using the migraine disability assessment (MIDAS) questionnaire: a comparison of chronic migraine with episodic migraine. Headache. 2003. 43:336–342.

17. Guitera V, Muñoz P, Castillo J, Pascual J. Quality of life in chronic daily headache: a study in a general population. Neurology. 2002. 58:1062–1065.

18. Lantéri-Minet M, Duru G, Mudge M, Cottrell S. Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: a systematic review. Cephalalgia. 2011. 31:837–850.

19. Headache Classification Committee. Olesen J, Bousser MG, Diener HC, Dodick D, First M, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006. 26:742–746.

20. Stewart WF, Lipton RB, Kolodner K, Liberman J, Sawyer J. Reliability of the migraine disability assessment score in a population-based sample of headache sufferers. Cephalalgia. 1999. 19:107–114. discussion 174.

21. Bjorner JB, Kosinski M, Ware JE Jr. Calibration of an item pool for assessing the burden of headaches: an application of item response theory to the headache impact test (HIT). Qual Life Res. 2003. 12:913–933.

22. Dodick D, Freitag F. Evidence-based understanding of medication-overuse headache: clinical implications. Headache. 2006. 46:Suppl 4. S202–S211.

23. Dodick DW. Clinical practice. Chronic daily headache. N Engl J Med. 2006. 354:158–165.

24. Shin HE, Han SJ, Lee KS, Park JW. Polymorphism of the Glutamate Transporter Protein EAAT2 and Migraine Transformation into Chronic Daily Headache. J Clin Neurol. 2011. 7:143–147.

25. Bigal ME, Ashina S, Burstein R, Reed ML, Buse D, Serrano D, et al. Prevalence and characteristics of allodynia in headache sufferers: a population study. Neurology. 2008. 70:1525–1533.

26. Lipton RB, Bigal ME, Ashina S, Burstein R, Silberstein S, Reed ML, et al. Cutaneous allodynia in the migraine population. Ann Neurol. 2008. 63:148–158.

27. Fusco BM, Colantoni O, Giacovazzo M. Alteration of central excitation circuits in chronic headache and analgesic misuse. Headache. 1997. 37:486–491.

28. Facchinetti F, Sances G, Martignoni E, Pagani I, Nappi G, Genazzani AR. Evidence of alpha-N-acetyl beta-endorphin in human cerebrospinal fluid. Brain Res. 1992. 586:1–5.

29. De Felice M, Ossipov MH, Wang R, Lai J, Chichorro J, Meng I, et al. Triptan-induced latent sensitization: a possible basis for medication overuse headache. Ann Neurol. 2010. 67:325–337.

30. Supornsilpchai W, le Grand SM, Srikiatkhachorn A. Cortical hyperexcitability and mechanism of medication-overuse headache. Cephalalgia. 2010. 30:1101–1109.

31. Mathew NT. Drug-induced headache. Neurol Clin. 1990. 8:903–912.

32. Rapoport A, Stang P, Gutterman DL, Cady R, Markley H, Weeks R, et al. Analgesic rebound headache in clinical practice: data from a physician survey. Headache. 1996. 36:14–19.

33. Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB. Transformed migraine and medication overuse in a tertiary headache centre--clinical characteristics and treatment outcomes. Cephalalgia. 2004. 24:483–490.

34. Lantéri-Minet M, Auray JP, El Hasnaoui A, Dartigues JF, Duru G, Henry P, et al. Prevalence and description of chronic daily headache in the general population in France. Pain. 2003. 102:143–149.

35. Cassidy EM, Tomkins E, Hardiman O, O'Keane V. Factors associated with burden of primary headache in a specialty clinic. Headache. 2003. 43:638–644.