Inpatient withdrawal treatment for chronic migraine with medication overuse and follow-up

Abstract

Objective: To investigate a group of CM with medication overuse patients before and after inpatient withdrawal pharmacological program and after a long-term follow-up. Methods: We hospitalized 114 CM patients with medication overuse (11M, 103F, mean age 48.6 +/- 14.5) at our Headache and Pain Unit for 15 days and re-contacted them after discharging. We collected data at baseline (T0) and followed-up after 3 (T3), 6 (T6), 12 (T12), 18 (T18), 24 (T24), 36 (T36), 48 months (T48). Inpatients were treated by discontinuation of the overused drugs and with a therapeutic protocol including i. v. dexamethasone, hydratation, anxiolytic and antidepressant therapy. Patients started prophylactic drugs and underwent to psychological and behavioural therapy to identify triggers and promote healthy life style. Once a day cranium-sacral and hydrokinesis therapy was applied as coadjuvant approach. Migraine disability was assessed by MIDAS, depression with Beck Depression Inventory (BDI) and anxiety with State Trait Anxiety Inventory (STAI-1, STAI-2) questionnaires. Quality of life was assessed using Short Form-36 Healthy Survey (SF-36). Results: A comparison of MIDAS total scores between baseline (120.2 +/- 71.5) and other timelines showed a significant reduction at T3 (56.5 +/- 59.9 p<0.001) and it was not lost at the others timelines of follow-up (T6: 56.4 +/- 60.9 p<0.001; T12: 61.9 +/- 68.8, p<0.001; T18: 71.2 +/- 64.8, p<0.002; T24: 65.6 +/- 64.8 p< 0.001; T36: 63.5 +/- 64.3 p<0.001; T 48: 72 +/- 64.9 p<0.002). Days of headache were T0: 63.2 +/- 25.7; T3: 28.1 +/- 24.3 (p<0.001); T6: 26 +/- 22.6 (p<0.001); T12: 28.1 +/-23.1 (p< 0.001); T18 30.7 +/- 25.9 (p<0.001); T24: 30.5 +/- 23.5 (p<0.001); T36 38.5 +/- 31.7 (p<0.001); T48:41.7 +/- 33.4 (p<0.002). STAI 1 score did not differ at any time, STAI-2 and BDI scores significantly reduced at T3 and maintained the increment at other times. Physical pain, social activity and mental health of SF-36 significantly improved at any timelines of follow-up. Conclusions: Different factors can contribute to the development and perpetuation of medication overuse in chronic migraine. Withdrawal in hospital setting is considered the first step for helping these patients to stop medication overuse.