Acute Medication Overuse, Symptom Severity Associated in Migraine

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Criteria for acute medication overuse were met by 15.4% of the subjects.
Criteria for acute medication overuse were met by 15.4% of the subjects.

Acute medication overuse in migraine may be associated with greater symptom severity and pain intensity as well as higher rates of cutaneous allodynia, according to a study recently published in The Journal of Headache and Pain.

This study included 13,649 respondents with a mean age of 43.4 (SD 13.6) years and who were 72.9% women and 81.9% Caucasian. Criteria for acute medication overuse were met by 15.4% of the subjects, who by comparison with the non-overuse group were less likely to be on nonsteroidal anti-inflammatory drugs (63.3% vs 69.8%, respectively) and more likely to take ergot alkaloids (3.1% vs 0.6%, respectively), barbiturates (7.8% vs 2.7%, respectively), opioids (23.8% vs 8.0%, respectively), and triptans (31.3% vs 14.2%, respectively; P <.001 for all).

Patients with vs without acute medication overuse also experienced more monthly headache days (12.9 vs 4.3, respectively), a greater severity of migraine symptoms (17.8 vs 16.4, respectively); greater scores on pain intensity (7.4 vs 6.5, respectively), and increased rates of cutaneous allodynia (53.7% vs 37.5%, respectively; P <.001 for all). After adjusting for monthly headache days, the likelihood of acute medication overuse grew with incremental years of age (odds ratio [OR]=1.02), smoking status (OR=1.54), being married (OR=1.19), showing psychological symptoms (OR=1.62) or cutaneous allodynia (OR=1.22), increased pain intensity (OR=1.27) and acuteness of migraine symptoms (OR=1.06). The risk for acute medication overuse due to cutaneous allodynia was greater in men (OR=1.61) but not women (OR=1.08).

Criteria for eligibility in this study included presence of migraine according to the International Classification of Headache Disorders-3-beta, more than 3 monthly headache days within the past 90 days and at least one in the last 30 days, and current use of medication for acute headache. 

The study researchers conclude that “[Acute medication overuse] was present in 15% of respondents with migraine. [Acute medication overuse] was associated with higher symptom severity scores, pain intensity, and rates of cutaneous allodynia. [Acute medication overuse] was more likely in triptan, opioid, and barbiturate users but less likely in [nonsteroidal anti-inflammatory drug] users. Cutaneous allodynia was associated with [acute medication overuse] in men but not women. This gender difference merits additional exploration.”

This study was sponsored by Promius Pharma, a subsidiary of Dr. Reddy's Laboratories, Princeton, NJ, USA.

Reference

Schwedt TJ, Alam A, Reed ML, et al. Factors associated with acute medication overuse in people with migraine: results from the 2017 migraine in America symptoms and treatment (MAST) study [published online May 24, 2018]. J Headache Pain. doi: 10.1186/s10194-018-0865-z

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