Page 57 - The clinical aspects and management of chronic migraine Judith Anne Pijpers

A. No headache nurse (n=163)
Medication withdrawal
Successful 99 (60.7%) Not successfula 64 (39.3%)
B. Headache nurse (n=253) p
185 (73.1%) 0.008b 68 (26.9%)
Support by a headache nurse during withdrawal
Table 2. Successful medication withdrawal, defined as a two- to three-month medication- and caffeine- free period, in patients with medication-overuse headache following withdrawal therapy without (group A) and with (group B) support by a headache nurse (n = 416).
Values are the absolute numbers with corresponding %.
a Including patients who are lost to follow-up and therefore considered not successfully withdrawn 44 (27.0%) resp. 31 (12.3%). b χ2 test
Table 3: Odds Ratios (1. univariate; 2. multivariate, adjusted for all mentioned covariates) for successful withdrawal, defined as a two- to three-month medication- and caffeine-free period (n = 416).
3
Variable
Gender Male
Female Age
Headache nurse No support
Support
Headache days (baseline) Non-daily
Daily
Medication Analgesics
Triptans Analgesics/triptans Other
Caffeine usea
Medication days (baseline) Non-daily
Daily
1. Univariate OR (95% CI)
1.00
1.09 [0.69 – 1.72] 0.98 [0.96 – 0.99]
1.00
1.76 [1.16 – 2.68]
1.00
0.97 [0.64 – 1.48]
1.00
0.97 [0.44 – 2.16] 0.87 [0.55 – 1.38] 0.55 [0.25 – 1.20]
0.99 [0.94 – 1.05]
1.00
0.54 [0.35 – 0.81]
p 2. Multivariate OR (95% CI) a p
. 1.00 .
0.72 0.88 [0.53 – 1.44] 0.60 0.002 0.98 [0.96 – 0.99] 0.017
. 1.00 . 0.008 1.73 [1.11 – 2.71] 0.016
a n=409, due to missing data. OR: odds ratio; CI: confidence interval
Variables associated with response and relative reduction to withdrawal therapy
The support by a headache nurse was not associated with response (OR: 1.42; 95% CI, 0.78–2.60; p=0.25) (Table 4). The responder rate, defined as the percentage of patients with ≥50% reduction in headache days, was not significantly different in both groups (no support 35.5%, with support 46.0%, p=0.098, Figure 2). The relative reduction in headache frequency, also showed no significant association with support by a headache nurse (B: 1.92; 95% CI, -7.75–11.60; p=0.70) This indicates that there is no effect of the support by the headache nurse on reduction of headache days when successfully withdrawn. The underlying primary headache disorder, that remained after the withdrawal,
. 1.00 0.90 1.36
. 1.00 0.94 1.22 0.55 0.80 0.14 0.68
0.84 1.00 . 1.00
. [0.82 – 2.25] 0.24
. [0.52 – 2.25] 0.65 [0.50 – 1.30] 0.37 [0.29 – 1.61] 0.38
[0.94 – 1.06] 0.93 .
0.003 0.50 [0.30 – 0.83] 0.008
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