The categorization of headaches related to drug overuse differs according to international criteria


More patients with chronic daily headaches are classified as having drug overuse headache (MOH) in the category International Classification of Headache 3 Beta (ICHD-3 beta) against criteria International Classification of Headache, Revision II (ICHD II R), according to the results of a study published in Clinical Neurology and Neurosurgery.

The study also found that in women, a higher visual analogue scale score and lower education level were the best predictors of MOH in patients with chronic daily headaches.

Indian researchers recruited a total of 202 consecutive patients with long-lasting chronic daily headaches (median age, 32 years [range, 18 to 65 years]) who attended an outpatient neurology clinic between 2014 and 2015. Patients were diagnosed with long-lasting chronic daily headaches if they had a headache frequency ≥ 15 days / month for approximately 3 months with untreated headaches lasting > 4 hours.

The severity of the headache was rated on a scale of 0 (none), 1 (mild), 2 (moderate) to 3 (severe). The researchers also calculated each participant’s in-hospital anxiety and depression score. A questionnaire was used to obtain information about the patients’ migraine triggers. Using the ICHD II R criteria, patients were assigned to the group of patients with chronic daily migraine or chronic tension headache. Patients were also diagnosed with MOH using both the ICHD II R criteria (n = 25) and the ICHD-3 beta criteria (n = 94).

A greater percentage of patients met MOH ICHD-3 beta criteria compared to patients who met ICHD II R criteria (46.5% vs. 12.3%, respectively). According to the ICHD-3 beta criteria, patients with MOH had fewer years of education (9.48 ± 6.03 vs. 11.69 ± 5.35; P = 0.001), a higher visual analog scale score (6.15 ± 1.20 vs. 5.63 ± 1.07; P = 0.002) and a higher number of total migraine triggers (7.79 ± 2.67 vs. 7.03 ± 2.90; P = 0.05) compared to patients with chronic daily headaches.

According to the ICHD II R criteria, patients with MOH had fewer years of education than patients with chronic daily headaches (6 ± 5.34 vs 10.89 ± 5.73, respectively; P
= .001). Patients with chronic daily migraine and MOH also had a higher total number of migraine triggers (8.32 ± 2.13 vs. 7.25 ± 2.8; P = .03).

Predictors of MOH in patients with chronic daily headache, based on multivariate analysis, included women (odds ratio [OR], 3.72; 95% CI, 1.72-8.02; P = 0.001), lower education level (OR, 1.07; 95% CI, 1.02-1.13; P = 0.007) and a higher visual analogue scale score (OR, 0.67; 95% CI, 0.51-0.88; P = .004). In comparison with the ICHD II R criteria, the patients who fulfilled the diagnosis of MOH according to the ICHD-3 beta criteria had a higher level of education (P = .02), and took less medication to stop the migraine attacks, during the relapse (P
= .03).

Limitations of the study include the cross-sectional nature of the analysis, the small sample size, and the lack of follow-up to assess withdrawal of medications to stop migraine attacks during relapses.

The discovery that the female sex was associated with MOH can be explained by the fact that women have “an inherent susceptibility to migraine, due to the influence of female hormones”, according to the investigators.

Reference

Laskar S, Kalita J, Misra UK. Comparison of chronic daily headaches with and without T headache due to drug abuse according to ICHD II R and ICHD 3 beta criteria. Clin Neurol Neurosurgery. 2019; 183: 105382.


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