In patients with chronic migraine plus medication-overuse headache (CM+MOH), childhood traumas and recent stressful life events merit consideration, particularly with respect to detoxification therapy. A study was conducted at the Headache Center, a tertiary referral center, of the C. Mondino National National Neurological Institute in Pavia, Italy. The results of the analysis were published in the journal Frontiers in Neurology.
The investigators sought to evaluate whether early traumatic experiences and current stressful life events are predictors, along with psychiatric conditions, of outcomes of detoxification treatment in patients with CM+MOH in a 2-month follow-up study. They analyzed consecutive patients who were undergoing a detoxification program as therapy for CM+MOH. Throughout the detoxification program, which lasted approximately 1 week, all of the participants received the standard inpatient withdrawal protocol, which included abruptly discontinuing the overused drug(s) and administering daily detoxification treatment.
Data regarding childhood traumatic events and recent stressful life events were evaluated via the Childhood Trauma Questionnaire and Stressful Life-Events Questionnaire. Psychiatric disorders were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders.
A total of 166 patients completed the follow-up 2 months after the detoxification program. The mean participant age was 44.7 years; 80% were women. Overall, 71% (118 of 166) of the participants stopped medication overuse and reverted to an episodic pattern of headache (Group A); 11% (19 of 166) continued to overuse medication and maintained a chronic pattern of headache (Group B); and 17% (29 of 166) stopped the overuse of medication, but their headache frequency continued to maintain a chronic pattern (Group C).
Per multivariate analyses, a higher number of early life emotional traumatic experiences was a significant prognostic factor for the outcomes reported in Group B (odds ratio [OR], 11.096; P =.037), whereas major depression experienced during an individual’s lifetime and a higher number of severe stressful episodes in the past 10 years were both significant prognostic factors for the outcomes observed in Group C (OR, 3.703; P =.006 and OR, 1.679; P =.045, respectively).
The investigators concluded that data from the current analysis imply that traumas in early life and stressful events have a negative impact on outcomes of a detoxification program in individuals with CM+MOH. The study findings demonstrate that the history of emotional childhood traumas is linked to the failure to cease medication overuse, whereas recent serious life events are related to the persistence of headache chronicity.
Bottiroli S, Galli F, Viana M, et al. Negative short-term outcome of detoxification therapy in chronic migraine with medication overuse headache: role for early life traumatic experiences and recent stressful events [published online March 7, 2019]. Front Neurol. doi:10.3389/fneur.2019.00173