Page 51 - The clinical aspects and management of chronic migraine Judith Anne Pijpers

Support by a headache nurse during withdrawal
Introduction
Medication Overuse Headache (MOH) is a highly disabling headache disorder, with a population based prevalence of 0.7 - 1.7% and a preponderance in women.1–3 The prevalence in headache clinics ranges from 30% in Europe to more than 50% in the USA.1,2 MOH is defined in the ICHD-III-beta criteria as headache occurring on half or more days per month as a consequence of regular overuse of acute headache medication (on ≥10 or ≥15 days per month, depending on the type of medication) for more than 3 months.4 Although consensus about the optimal treatment for MOH is not yet reached, withdrawal of the overused medication is strongly suggested as an essential component in the management of MOH, to reduce headache frequency and improve responsiveness to both acute and prophylactic therapy.1,2,5,6 Several studies have compared different treatment strategies2,7 and some suggested that a simple withdrawal advice is effective.8,9 In compliance with those studies, acute withdrawal without any concomitant therapy is advised in the national headache guidelines of the Netherlands, and common practice. However, a well-defined selection of patients prone to benefit from simple withdrawal advice, has not been established. Withdrawal programmes are increasingly multidisciplinary coordinated, with implementation of patient education and motivational or cognitive behavioural therapy, often realized by a headache nurse.10–14 Despite of this, the effectiveness of a headache nurse in withdrawal therapy has never been studied in a controlled follow up study. Therefore, the objectives of this study are (i) to determine whether support of a headache nurse in the treatment of MOH increases successful withdrawal, and (ii) to investigate intrinsic patient factors associated with response to withdrawal therapy.
Methods
Study design and population
The current study used a retrospective controlled follow-up approach. Participants were recruited during a period of four years (1 April 2006 - 31 March 2010) among all new patients at the specialized outpatient headache clinic of the Leiden University Medical Centre (LUMC), functioning both as a primary and secondary referral centre with referrals from general practitioners
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