Medication Overuse Headache Categorization Differs by International Criteria

More patients with chronic daily headache are categorized as having medication overuse headache (MOH) under the International Classification of Headache Disorder 3 Beta (ICHD-3 beta) criteria compared with the International Classification of Headache Disorder II Revision (ICHD II R) criteria, according to study results published in Clinical Neurology and Neurosurgery.

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

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

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

A greater percentage of patients fulfilled the ICHD-3 beta criteria for MOH vs patients who fulfilled the 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 =.001), a higher visual analogue scale score (6.15±1.20 vs 5.63±1.07; P =.002), and a higher number of total migraine triggers (7.79±2.67 vs 7.03±2.90; P =.05) compared with patients with chronic daily headache.

According to the ICHD II R criteria, patients with MOH had fewer years of education compared with patients with chronic daily headache (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, according to a multivariate analysis, included women (odds ratio [OR], 3.72; 95% CI, 1.72-8.02; P =.001), lower education level (OR, 1.07; 95% CI, 1.02-1.13; P =.007), and higher visual analogue scale score (OR, 0.67; 95% CI, 0.51-0.88; P =.004). In comparison with the ICHD II R criteria, patients who fulfilled the diagnosis of MOH per the ICHD-3 beta criteria had a higher education level (P =.02), and took less medication to stop migraine attacks, during the flare (P =.03).

Study limitations include the cross-sectional nature of the analysis, the small sample size, and the lack of follow-up to assess the withdrawal of drugs to stop migraine attacks during flares.

The finding that female sex was associated with MOH may be explained by females having “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 headache with and without medication overuse T headache using ICHD II R and ICHD 3 beta criteria. Clin Neurol Neurosurg. 2019;183:105382.