Adverse Childhood Events Associated With Medication Overuse Headache

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Known risk factors for medication overuse headache include smoking, anxiety, family history of substance abuse, migraine history, depression, and obsessive-compulsive disorder.
The following article is part of conference coverage from the 2018 American Headache Society Annual Scientific Meeting in San Francisco, California. Neurology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in neurology. Check back for the latest news from AHS 2018.

SAN FRANCISCO — An adverse childhood experience (ACE) appears to be associated with opioid and narcotics overuse as well as the development of medication overuse headache (MOH), according to a study presented by Claire Sandoe, MD, of the University of Toronto in Ontario, Canada, at the 60th Annual Scientific Meeting of the American Headache Society. Additionally, patients with MOH with an ACE were less likely to reduce or eliminate MOH if they overuse narcotics, the researchers reported.

Currently, there is a lack of knowledge among researchers and clinicians regarding the development of MOH as well as MOH-related treatment resistance. Known risk factors for the disorder include smoking, anxiety, family history of substance abuse, migraine history, depression, and obsessive-compulsive disorder. Opioids and barbiturates carry the highest risk for MOH, according to the study researchers. “Many patients with MOH meet DSM criteria for dependence on their overused medications, and indeed MOH has been posited to exist on a spectrum with substance abuse disorders,” Dr Sandoe and colleagues wrote. “ACE is a risk factor for the development of chronic migraine and chronic daily headache, possibly through the over-sensitization of brain pain pathways in early life.”

In their retrospective analysis, the researchers assessed the association between ACE and MOH, with a specific focus on narcotic use in patients with MOH. A medical chart review of patients attending the University of Toronto Women’s College Hospital Centre for Headache during a 1-year period was performed. Patients included in the study had chronic daily headache or migraine (with or without aura) and MOH. Additionally, patients had ≥1 follow-up hospital visit during the first 6 months of treatment.

A total of 72 patients, of whom 85% were female, were included in the study. At baseline, the reported duration of chronic headache and MOH was 10±11 years (range 1-50) and 6±10 years (range 1-40), respectively. Approximately 39% (n=28) of patients reported narcotics overuse, whereas 54% (n=37) reported an ACE. No difference was found between patients with and without an ACE in terms of the Migraine Disability Assessment score (91±70 vs 86±83, respectively). In addition, there was no difference between patients with vs without an ACE in regard to total headache days per month (26±4 vs 25±4, respectively).

A significantly greater proportion of patients with a psychiatric diagnosis at baseline reported an adverse childhood event (73% vs 45%; P =.02). Investigators also observed a significant trend towards narcotics overuse in patients with vs without an ACE (49% vs 26%, respectively; P =.05). There was also a significantly greater proportion of patients with opioid overuse who had reported an ACE (32% vs 3%; P =.002).

While there appeared to be a trend towards ongoing drug overuse in patients with ACE vs without ACE, this finding was non-significant (33% vs 19%, respectively; P =.2). Ongoing substance overuse was greater among patients using narcotics (52% vs 12%; P =.003). Additionally, the researchers observed a non-significant trend towards reduced improvement in Migraine Disability Assessment scores in patients reporting an ACE vs those without an ACE (-33±61 vs -69±85, respectively; P =.18).

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“Future work will include a longer follow-up period to examine relapse rates in patients with MOH and ACE, and whether different types of ACE have different prognoses,” the researchers concluded. “Patients with ACE may benefit from more intensive psychotherapy-based approaches to treating their MOH.”

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Sandoe C, Lawler V, Lena S, et al. Adverse childhood experience and medication overuse headache: frequency and effects on response to treatment. Presented at: The American Headache Society 60th Annual Meeting. June 28-July 1, 2018; San Francisco, CA. Abstract 486817.