Factors Associated with Medication-Overuse Headache in Patients Seeking Treatment for Primary Headache

Although a number of risk factors for medication-overuse headache (MOH) have been identified within the general population, limited research exists examining clinical samples of headache sufferers. Further, prior studies have not assessed the relative influence of risk factors or their utility in combination. As part of an online survey, 164 headache patients completed a demographic questionnaire, a diagnostic interview for headache, a measure of headache-related disability, measures of psychiatric symptoms, and measures of medication use and substance use. Standardized mean differences were used to quantify differences between patients who met diagnostic criteria for MOH and those who did not across five domains of predictors (demographic characteristics, headache characteristics, psychiatric symptoms, medication use, and substance use). The variables within each domain that best discriminated between those who met criteria for MOH and those who did not were identified using a classification tree approach with Bonferroni corrections. Candidate variables were then entered into a multivariate logistic regression to predict MOH status. Forty-three of the 164 patients (26.2%) of the sample met diagnostic criteria for MOH. Patients with MOH were more disabled by their headaches (mean [SD]: 67.60 [6.00] vs 63.31 [6.68]) and reported more escape and avoidance behaviors in response to headache pain (14.64 [5.36] vs 10.44 [6.13]. The use of combination medication for the treatment of headache (60.5% vs 33.1%, odds ratio 3.10, 95% confidence interval [CI] 1.51-6.36) was associated with more than a threefold risk of MOH. These three variables were forced into a final multivariate model, which differentiated well between the two groups (area under the receiver operating characteristic curve = .78; 95% CI .71-.86). Based on these results, headache-related disability, fear and avoidance of pain-related stimuli, and the use of combination medications for the treatment of headache best predict MOH among treatment-seeking headache sufferers. Brief screening measures that assess relevant risk factors may be used to aid in the identification of headache patients most likely to have MOH and behavioral and cognitive-behavioral interventions may hold promise for the prevention of MOH and the reduction of acute medication use among individuals with MOH.

Name thesis:degree_name

Ph.D. in Psychology

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Psychology

Year dc:date.available

2017

Author dc:creator

• Peck, Kelly Reed

Contributors dc:contributor

• Todd A. Smitherman
• John P. Bentley
• Stefan E. Schulenberg

• depression
• disability
• fear of pain
• headache
• medication overuse
• medication overuse headache
• Clinical Psychology

Repository record dc:identifier

https://egrove.olemiss.edu/etd/1524

OAI identifier oai:identifier

oai:egrove.olemiss.edu:etd-2523