Chronic Migraine with Medication Overuse: Clinical Pattern and Evolution from a Retrospective Cohort in Seville, Spain
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MEDICINE
Chronic Migraine with Medication Overuse: Clinical Pattern and Evolution from a Retrospective Cohort in Seville, Spain María del Valle López Martínez 1 & Javier Pareja Román 2 & María Dolores Jiménez Hernández 1 & Ceferino Maestu Unturbe 3 & María del Carmen Ramírez-Castillejo 2 Accepted: 17 July 2020 # Springer Nature Switzerland AG 2020
Abstract Chronic migraine (CM) with medication overuse (MO) develops in patients with a pre-existing primary headache after a regular overuse of symptomatic medication. In these patients, headache crisis may occur together with other painful pathologies which can increase the frequency and intensity of the pain episodes. Such comorbidities need to be assessed as they influence the clinical evolution of the patients. A cohort of 102 patients (89 women and 13 men) with a diagnosis of chronic migraine (CM) with medication overuse (MO) was retrospectively analysed. Patients enrolled in the study were actively followed up 23 months in the Neurology Service of the University Hospital Virgen del Rocío in Seville, Spain. We observed that most of the patients overused multiple symptomatic drugs (34.3%) and NSAIDs (26.5%). In this cohort, the most effective treatments were topiramate and the combination of multiple prophylactic drugs with an effectiveness of 41.6% and 53.8%, respectively, at the end of the study. We observed the ratio of patients reducing their headache crisis was significantly higher among patients abandoning their medication overuse. Detoxification, or withdrawal of medication overuse, is linked to the reduction of the frequency and intensity of 50% or more of the headache crisis in these patients. Keywords Medication overuse . Detoxification . Headache comorbidities . Preventive treatment
Introduction Chronic migraine (CM) with medication overuse (MO) is the most prevalent chronic headache disorder [1]. It is classified as a secondary headache disorder that develops in some patients with a pre-existing primary headache as a consequence of a regular overuse of any type of analgesics or any other acute or symptomatic headache medication. According to the This article is part of the Topical Collection on Medicine * María del Valle López Martínez [email protected] * Javier Pareja Román
1
Neurology Service, University Hospital Virgen del Rocío, Seville, Spain
2
Health Science Technologies Research Group, Biotechnology-BV ETSIAAB Department, Universidad Politécnica de Madrid, Madrid, Spain
3
Centro de Tecnología Biomédica, Universidad Politécnica de Madrid, Madrid, Spain
International Classification of Headache Disorders, chronic migraine (CM) with medication overuse (MO) is defined as a headache occurring on 15 or more days/month in a patient with a pre-existing headache disorder with a regular medication overuse for more than three months that does not better account for any other diagnosis [2]. It represents the third most prevalent headache condition overall, after migraine and tension-type headache. Chronic migraine with medication overuse has
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