Page 92 - The clinical aspects and management of chronic migraine Judith Anne Pijpers

Chapter 5
Abstract
Objective To assess efficacy of behavioural intervention in Medication Overuse Headache (MOH) with underlying migraine.
Methods In this concealed, double-blind, randomised controlled trial in MOH patients with underlying migraine we compared the effect of maximal versus minimal behavioural intervention by a headache nurse, during withdrawal therapy at the outpatient Headache Clinic of the Leiden University Medical Center. Maximal intervention consisted of an intensive contact schedule, comprising of education, motivational interviewing and value-based activity planning during the 12 weeks of acute withdrawal. Minimal intervention consisted of one short contact only. Patients were unaware of the existence of these treatment arms, as the trial was concealed in another trial investigating the added value of botulinum toxin A to withdrawal therapy. Endpoints were successful withdrawal and monthly days of acute medication use after the withdrawal period.
Results We enrolled 179 patients (90 maximal intervention; 89 minimal intervention). At week 12, most patients achieved withdrawal in both groups (82/90 (93%) maximal intervention versus 75/89 (86%) minimal intervention, OR 2.44 (95%CI 0.83;7.23), p=0.107). At week 24, patients in the maximal intervention group had fewer acute medication days per month (mean difference -2.23, 95%CI: -3.76;-0.70, p=0.005). This difference receded over time.
Conclusion Intensive behavioural intervention by a headache nurse during withdrawal therapy for MOH patients is beneficial to reduce acute medication use during and shortly after the intervention, but extension of guidance seems warranted for a prolonged effect. A concealed study design may also be useful to investigate non-pharmacological therapies in other central nervous system disorders.
Trial register identifier www.trialregister.nl; NTR3440
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