Chronic headache and medication overuse: analysis of patients and medical interventions

Introduction: The lack of standardized approaches makes it more difficult than is the case for episodic headaches the evaluation of the outcomes of the process of care to patients with chronic headache and medication overuse. The aim of this study was to analyse, critically, both the characteristics of chronic headache patients and the way they are managed. Methods: We reviewed all the medical records of patients admitted to the Day Hospital of the Headache Centre in the second semester of 2012. Results: Eighty female patients (mean age 52 years) had been admitted to the Day Hospital; 42% of them had already been hospitalized at least once, even in the 3 previous years. The headache had started as episodic with menarche in 38% of patients and it had become chronic on average after 22 years. All patiens made overuse of prescription medications: 70% NSDAIDs; 49% triptans; 19% combination of indomethacin, prochlorperazine and caffeine; 7.5% combination of codeine and paracetamol; 6.3% combination of butalbital, propyphenazone and caffeine; 6.3% tramadol. Fifty-two percent of the patients had previously taken at least three prophylactic treatments. During the hospitalization several lab tests and consultations had been carried out. Discussion: Medication-overuse no longer appears as a consequence of the barriers that the headache patients, particularly migraine sufferers, encounter to access to health care. In fact, most of the patients examined were taking prescription medications, prophylactic treatments and were regularly followed by the Centre and by other specialists for years. Conclusion: Patients with chronic headache and medication overuse are now intensely medicalized without decisive benefits and with the risk that their condition being crystallized even more as chronic and intractable. This categorization could impede the research of different and more effective interventions by physicians and patients.