When people have upwards of 15 or more Migraine attacks or headaches per month, it can become difficult to treat them due to the risk of medication overuse headache (MOH). Medication overuse headache may occur if we take Migraine abortive medications such as triptans or any kind of pain medication -- prescription or over-the-counter -- more than two or three days a week. Diagnosing MOH can be time consuming and frustrating for physicians and patients. At the International Headache Society's Scientific Congress in June this year, Dr. Virginie Dousset, director of the Bordeaux Headache Centre at the University of Bordeaux in France, along with her colleagues, discussed using a quicker screening method to determine if patients are in fact having medication overuse headache.  

Typically the way to determine whether or not a patient has MOH begins with a doctor's appointment, which places time constraints and also require a bit of skill in headache medicine. To reduce time issues and confusion regarding MOH (which benefits both patient and doctor alike), Dr. Dousset and her team were able to design a questionnaire to see which patients were likely to have MOH. To do so, they used criteria from the International Classification of Headache Disorders (ICHD-II) for MOH. 

This study at the French headache centre recruited 79 first time patients (between September 2009 and February 2010). Of these 79 patients, 42 had medication overuse headache, two patients withdrew and 35 were Migraineurs who were also examined for medication overuse headache. The group consisted of men and women over the age of 18, and had no primary headache disorder other than Migraine. Both the Migraine and medication overuse group had mostly women in them, and in each, 81% had medication overuse headache and 63% had Migraine. The questionnaire was self explanatory, patients were supervised but unassisted while a nurse observed, and the doctor was unaware of the results. The questions were:

• "Do you take an attack treatment more than 10 days per month?"
• "Is this intake on a regular basis?"

The outcome of this project is similar to another study done in 2008 that showed a sensitivity of 75% and specificity of 100% for medication overuse headache in patients having 15 or more days a month of Migraine and who treated their Migraine more than 4 days a week. In the Dousset study, the sensitivity was 95% and 80% for medication overuse headache identification. This can be an important tool for doctors, not just in the headache clinic, but in a primary care doctor's office as well because MOH can be so disabling. In today's busy health care industry, doctors overloaded schedules and patients need for information, this may be a win-win for both parties.

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Sources:

MCNamara, Damian. Simple Questions Accurately Screen for Medication Overuse Headache. Internal Medicine News. Digital Network. July 15, 2011.  

Thanks for reading and feel well,