Medication overuse headache and awareness

Background: Medication overuse headache (MOH) is the worsening of an underlying headache due to the overuse of its acute treatment. Unintentionally, healthcare professionals may contribute to this condition. Health professionals play an important role in preventing this increasingly frequent and difficult-to-treat condition. Objective: To investigate MOH awareness among physicians with headache through a survey conducted among medical doctors on our university campus. Methods: This was an observational cross-sectional study about MOH awareness. The total number of medical doctors working in the Dokuz Eylül University Health Campus was provided by the administrative unit. A total of 18 questions were prepared and administered on a voluntary basis to obtain information about MOH awareness. Results: A total of 312 medical doctors were surveyed, including 198 (63.5%) from internal medical sciences, 81 (26%) from surgical medical sciences, and 33 (10.5%) from basic medical sciences. Half of the physicians in our sample were unaware of MOH. Our results showed that awareness of MOH, was quite low even among medical doctors. Conclusions: MOH causes both labor and financial losses to countries and impairs the quality of life of patients. Preventing excessive use of medications by raising awareness among doctors is an important step to prevent the development of MOH.

RESUMO

Antecedentes: A cefaleia por uso excessivo de medicamentos (CEM) é o agravamento de uma cefaleia subjacente devido ao uso excessivo do seu tratamento agudo. Involuntariamente, os profissionais de saúde podem contribuir para essa condição. Os profissionais de saúde desempenham um papel importante na prevenção dessa condição cada vez mais frequente e de difícil tratamento. Objetivo: Investigar a conscientização da CEM entre médicos com dor de cabeça por meio de uma pesquisa realizada entre médicos em nosso campus universitário. Métodos: Este foi um estudo transversal observacional sobre a consciência da CEM. O número total de médicos que trabalham no Campus de Saúde da Universidade Dokuz Eylül foi fornecido pela unidade administrativa. Um total de 18 questões foram preparadas e aplicadas de forma voluntária para obter informações sobre a conscientização da CEM. Resultados: Um total de 312 médicos foram pesquisados, incluindo 198 (63,5%) das ciências médicas internas, 81 (26%) das ciências médicas cirúrgicas e 33 (10,5%) das ciências médicas básicas. Metade dos médicos de nossa amostra desconhecia a CEM. Nossos resultados mostraram que o conhecimento sobre a CEM era bastante baixo, mesmo entre os médicos. Conclusões: A CEM causa perdas laborais e financeiras aos países e prejudica a qualidade de vida dos pacientes. Prevenir o uso excessivo de medicamentos por meio da conscientização dos médicos é um passo importante para prevenir o desenvolvimento da CEM.

Keywords:

Headache Disorders - Headache Disorders, Secondary - Migraine Disorders - Awareness - Socioeconomic Factors

Palavras-chave:

Transtornos da Cefaleia - Transtornos da Cefaleia Secundários - Transtornos de Enxaqueca - Conscientização - Fatores Socioeconômicos

Authors’ contributions:

All authors: contributed to the study conception and design, commented on previous versions of the manuscript and read and approved the final manuscript, material preparation, data collection and analysis were performed; ZTI: write the first draft of the manuscript.

Publication History

Received: 12 December 2020

Accepted: 22 March 2021

Article published online:
07 June 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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References
1 Westergaard ML, Hansen EH, Glumer C, Olesen J, Jensen RH. Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates: a systematic review. Cephalalgia. 2014 May;34(6):409-25. https://doi.org/10.1177/0333102413512033
2 Munksgaard SB, Jensen RH. Medication overuse headache. Headache. 2014 Jul-Aug;54(7):1251-7. https://doi.org/10.1111/head.12408
3 Cheung V, Amoozegar F, Dilli E. Medication overuse headache. Curr Neurol Neurosci Rep. 2015 Jan;15(1):509. https://doi.org/10.1007/s11910-014-0509-x
4 Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. https://doi.org/10.1177/0333102417738202
5 Shahbeigi S, Fereshtehnejad SM, Mohammadi N, Golmakani MM, Tadayyon S, Jalilzadeh G, et al. Epidemiology of headaches in Tehran urban area: a population-based cross-sectional study in district 8, year 2010. Neurol Sci. 2013 Jul;34(7):1157-66. https://doi.org/10.1007/s10072-012-1200-0
6 Ayzenberg I, Katsarava Z, Sborowski A, Chernysh M, Osipova V, Tabeeva G, et al. The prevalence of primary headache disorders in Russia: a countrywide survey. Cephalalgia. 2012 Apr;32(5):373-81. https://doi.org/10.1177/0333102412438977
7 Kendir Ai, Beckmann Y, Seçil Y, Eryaşar G, Başoğlu M. İlaç Aşırı Kullanım Baş Ağrısı Klinik ve Tedavi Özellikleri. Turkiye Klinikleri J Neur. 2009;4(3):122-7.
8 Diener H-C, Limmroth V. Medication-overuse headache: a worldwide problem. Lancet Neurol. 2004 Aug;3(8):475-83. https://doi.org/10.1016/S1474-4422(04)00824-5
9 Reuter U, Salomone S, Ickenstein G, Waeber C. Effects of chronic sumatriptan and zolmitriptan treatment on 5-HT1 receptor expression and function in rats. Cephalalgia. 2004 May;24(5):398-407. https://doi.org/10.1111/j.1468-2982.2004.00683.x
10 Tohyama Y, Yamane F, Fikre Merid M, Blier P, Diksic M. Effects of serotine receptors agonists, TFMPP and CGS12066B, on regional serotonin synthesis in the rat brain: an autoradiographic study. J Neurochem. 2002 Mar;80(5):788-98. https://doi.org/10.1046/j.0022-3042.2002.00757.x
11 Park JW, Kim JS, Kim YI, Lee KS. Serotonergic activity contributes to analgesic overuse in chronic tension-type headache. Headache. 2005 Oct;45(9):1229-35. https://doi.org/10.1111/j.1526-4610.2005.00247.x
12 Katsarava Z, Jensen R. Medication-overuse headache: where are we now? Curr Opin Neurol. 2007 Jun;20(3):326-30. https://doi.org/10.1097/WCO.0b013e328136c21c
13 Evers S, Marziniak M. Clinical features, pathophysiology, and treatment of medication-overuse headache. Lancet Neurol. 2010 Apr;9(4):391-401. https://doi.org/10.1016/S1474-4422(10)70008-9
14 Smith TR, Stoneman J. Medication overuse headache from antimigraine therapy: clinical features, pathogenesis and management. Drugs. 2004;64(22):2503-14. https://doi.org/10.2165/00003495-200464220-00002
15 Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache: a population-based study. Neurology. 2004 Dec;63(11):2022-7. https://doi.org/10.1212/01.wnl.0000145760.37852.ed
16 Colás R, Munoz P, Temprano R, Gomez C, Pascual J. Chronic daily headache with analgesic overuse: epidemiology and impact on quality of life. Neurology. 2004 Apr;62(8):1338-42. https://doi.org/10.1212/01.wnl.0000120545.45443.93
17 Orhan EK, Baykan B. Ilaç Asiri Kullanimi Basagrisi: Sik Ve Önlenebilir Bir Basagrisi Nedeni/Medication Overuse Headache: The Reason of Headache That Common and Preventable. Noro-Psikyatri Arsivi. 2013;50(Suppl 1):47. https://doi.org/10.4274/Npa.y7264
18 Ertas M, Baykan B, Orhan EK, Zarifoglu M, Karli N, Saip S, et al. One-year prevalence and the impact of migraine and tension-type headache in Turkey: a nationwide home-based study in adults. J Headache Pain. 2012 Mar;13(2):147-57. https://doi.org/10.1007/s10194-011-0414-5
19 Baykan B, Ertas M, Karli N, Akat-Aktas S, Uzunkaya O, Zarifoglu M, et al. The burden of headache in neurology outpatient clinics in Turkey. Pain Pract. 2007 Dec;7(4):313-23. https://doi.org/10.1111/j.1533-2500.2007.00154.x
20 Arslantas D, Tozun M, Unsal A, Ozbek Z. Headache and its effects on health-related quality of life among adults. Turk Neurosurg. 2013;23(4):498-504. https://doi.org/10.5137/1019-5149.JTN.7304-12.0
21 Benbir G, Karadeniz D, Göksan B. Türkiye’nin doğu ve kırsal kesiminde yaşa ve cinsiyete göre baş ağrısı özellikleri ve alt tipleri. Ağrı. 2012;24(4):145-52. https://doi.org/10.5505/agri.2012.85579
22 Deleu D, Khan M, Humaidan H, Al Mantheri Z, Al Hashami S. Prevalence and clinical characteristics of headache in medical students in Oman. Headache. 2001 Sep;41(8):798-804. https://doi.org/10.1046/j.1526-4610.2001.01146.x
23 Westergaard ML, Hansen EH, Glümer C, Jensen RH. Prescription pain medications and chronic headache in Denmark: implications for preventing medication overuse. Eur J Clin Pharmacol. 2015 Jul;71(7):851-60. https://doi.org/10.1007/s00228-015-1858-3
24 Feinstein AR, Heinemann L, Dalessio D, Fox JM, Goldstein J, Haag G, et al. Do caffeine-containing analgesics promote dependence? A review and evaluation. Clin Pharm Therap. 2000 Nov;68(5):457-67. https://doi.org/10.1067/mcp.2000.110974
25 Dodick DW, Silberstein S. How clinicians can detect, prevent and treat medication overuse headache. Cephalalgia. 2008 Nov;28(11):1207-17. https://doi.org/10.1111/j.1468-2982.2008.01737.x
26 Evers S, Gralow I, Bauer B, Suhr B, Buchheister A, Husstedt IW, et al. Sumatriptan and ergotamine overuse and drug-induced headache: a clinicoepidemiologic study. Clin Neuropharmacol. 1999 Jul-Aug;22(4):201-6.
27 Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: A longitudinal population-based study. Headache. 2008 Sep;48(8):1157-68. https://doi.org/10.1111/j.1526-4610.2008.01217.x
28 Limmroth V, Katsarava Z, Fritsche G, Przywara S, Diener H-C. Features of medication overuse headache following overuse of different acute headache drugs. Neurology. 2002 Oct;59(7):1011-4. https://doi.org/10.1212/wnl.59.7.1011
29 Da Silva AN, Lake III AE. Clinical aspects of medication overuse headaches. Headache. 2014 Jan;54(1):211-7. https://doi.org/10.1111/head.12223
30 Bigal ME, Lipton RB. Excessive acute migraine medication use and migraine progression. Neurology. 2008 Nov;71(22):1821-8. https://doi.org/10.1212/01.wnl.0000335946.53860.1d
31 Katsarava Z, Fritsche G, Muessig Ma, Diener H, Limmroth V. Clinical features of withdrawal headache following overuse of triptans and other headache drugs. Neurology. 2001 Nov;57(9):1694-8. https://doi.org/10.1212/wnl.57.9.1694
32 Zwart JA, Dyb G, Hagen K, Svebak S, Holmen J. Analgesic use: a predictor of chronic pain and medication overuse headache: the Head-HUNT Study. Neurology. 2003 Jul;61(2):160-4. https://doi.org/10.1212/01.wnl.0000069924.69078.8d
33 Lai JT, Dereix JD, Ganepola RP, Nightingale PG, Markey KA, Aveyard PN, et al. Should we educate about the risks of medication overuse headache? J Headache Pain. 2014 Feb;15(1):10. https://doi.org/10.1186/1129-2377-15-10
34 Hagen K, Linde M, Steiner T, Zwart JA, Stovner L. The bidirectional relationship between headache and chronic musculoskeletal complaints: an 11-year follow-up in the Nord-Trøndelag Health Study (HUNT). Eur J Neurol. 2012 Nov;19(11):1447-54. https://doi.org/10.1111/j.1468-1331.2012.03725.x
35 Bendtsen L, Munksgaard S, Tassorelli C, Nappi G, Katsarava Z, Lainez M, et al. Consortium COMOESTAS: Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project). Cephalalgia. 2014 May;34(6):426-33. https://doi.org/10.1177/0333102413515338
36 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 May;31(7):837-50. https://doi.org/10.1177/0333102411398400
37 Diener HC, Antonaci F, Braschinsky M, Evers S, Jensen R, Lainez M, et al. European Academy of Neurology guideline on the management of medication-overuse headache. Eur J Neurol. 2020 Jul;27(7):1102-16. https://doi.org/10.1111/ene.14268
38 Kristoffersen ES, Faiz KW, Winsvold BS. Neurology residents’ knowledge of the management of headache. Cephalalgia. 2019 Oct;39(11):1396-406. https://doi.org/10.1177/0333102419847973
39 Carlsen LN, Westergaard ML, Bisgaard M, Schytz JB, Jensen RH. National awareness campaign to prevent medication-overuse headache in Denmark. Cephalalgia. 2018 Jun;38(7):1316-25. https://doi.org/10.1177/0333102417736898

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