Page 53 - The clinical aspects and management of chronic migraine Judith Anne Pijpers
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Support by a headache nurse during withdrawal
of the withdrawal advice and elaboration on questions of the patient. The consequences for daily professional and social life were discussed and a plan of approach was assembled. Furthermore, strategies for pain management (other than medication treatment) were discussed. Subsequently, the headache nurse contacted all patients two weeks after initiation of the withdrawal period. Depending on the need for support of patients, the headache nurse had additional interaction during the withdrawal period, varying from one to six contacts (median three contacts) by telephone.
Measurement
Two trained examiners obtained medical information from the outpatient clinic administration, patient letters and medical files, using the same methods and criteria to select patients and classify data. The outcome measures were: i) successful withdrawal, defined as a completed medication- and caffeine- free period; ii) response, defined as ≥ 50% reduction in headache days after successful withdrawal; and iii) relative reduction in headache days after successful withdrawal, since a reduction <50% may be considered clinically relevant as well.16 The number of headache days at baseline and at follow up were collected to calculate outcomes measures. In case of missing data on response (n=25 patients), patients reporting ‘strong improvement’, ‘nearly no headache’ or ‘no headache’ at follow-up were considered as a ≥ 50% reduction in headache days(responder), and patients reporting ‘aggravation’, ‘no improvement’ or ‘some to moderate improvement’ at follow-up were considered as a < 50% reduction in headache days (non-responder). This subjective classification and the classification based on absolute change in headache days were highly correlated (n=75, r = 0.80, p<0.001). To be able to find associations between potential intrinsic determinants and our outcome measures, we collected data on gender, age, pre-existing headache type, final primary headache after successful withdrawal, number of headache days at baseline, number of medication days at baseline, type of overused medication, and caffeine units per day. Pre-existing headache and final primary headache at follow-up were classified according to ICHD-II/ICHD-III-b criteria4,15 as: i) migraine; ii) tension-type headache; and iii) combination of both migraine and tension-type headache. Because of the typical blurred presentation of primary headache at baseline, which is often the case during a period of medication overuse, the pre-existing headache was in some cases impossible to determine
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