Many People With Medication-Overuse Headache May Be Substance-Dependent

Patients with medication-overuse headache (MOH) often fit the criteria for substance dependence and high Severity of Dependence Scale (SDS) scores may be helpful for identifying dependence in this patient population, according to study results published in the Journal of Addiction Medicine.

A total of 60 patients with MOH, 15 patients with chronic headache without medication overuse, and 25 control individuals were recruited from a previously conducted randomized controlled trial. Headaches and substance dependence were diagnosed using the International Classification of Headache Disorders and the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), respectively. Interviewers blinded to the patients’ group evaluated SDS scores, the validity of which was assessed by comparing them with a substance dependence diagnosis, using receiver operating characteristic analysis.

Of the 60 patients with MOH, 37 (62%) and 23 (38%) were found to overuse simple analgesics and centrally acting analgesics (eg, codeine, opiates, and triptans), respectively.

Half of the patients with MOH were categorized as being substance-dependent according to DMS-IV criteria. The score on the SDS was higher in patients who were vs were not substance dependent (7.1 vs 2.7, respectively; P <.001).

Patients with MOH had higher SDS scores compared with controls (P <.001). Patients with substance dependence who did not achieve withdrawal had higher scores compared with patients without substance dependence (7.6; 95% CI, 6.6-8.5 vs 5.6; 95% CI, 4.7-6.4; P =.002).

Study limitations include the small sample size and the recruitment of Norwegian patients only.

“Disadvantages of a focus on dependence-like behavior, rest on the assumption that the consequences of such a focus may be negative for the patient,” the researchers noted. “If, on the contrary, negative stigmatization of the patient is avoided and the consequences are identification of the headache cause, increased likelihood of an effective treatment and a more careful prophylactic stance in the first place, then the advantages may well outweigh the disadvantages.”

Reference

Lundqvist C, Gossop M, Russell MB, Straand J, Kristoffersen ES. Severity of analgesic dependence and medication-overuse headache. [published online February 1, 2019]. J Addict Med. doi:10.1097/ADM.0000000000000504