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The severity of dependence scale detects people with medication overuse. The Akershus study of chronic headache
  1. Ragnhild Berling Grande (r.berling.grande{at}medisin.uio.no)
  1. Head and neck research group, Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway
    1. Kjersti Aaseth (kjersti.aaseth{at}medisin.uio.no)
    1. Head and neck research group, Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway
      1. Jûratë Saltytë-Benth
      1. Faculty Division Akershus University Hospital, University of Oslo, 1474 Nordbyhagen, Norway
        1. Pål Gulbrandsen
        1. HØKH, Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway
          1. Michael Bjørn Russell
          1. Head and neck research group, Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway
            1. Christofer Lundqvist
            1. Head and neck research group, Research Centre, Akershus University Hospital, 1478 Lørenskog, Norway

              Abstract

              Objective: To evaluate the Severity of Dependence Scale (SDS) in people with primary chronic headache and analyze pattern of medication overuse.

              Design: Cross-sectional epidemiological survey. A posted questionnaire screened for chronic headache. Neurological residents interviewed those with self-reported chronic headache. The International Classification of Headache Disorders was used. Split file methodology was employed for data analysis.

              Setting: Akershus University Hospital, Oslo, Norway.

              Participants: A random sample of 30 000 people, 30-44 years, from the general population of Akershus County, Norway. 405 people had primary chronic headache.

              Main outcome measure: SDS score in those with and without medication overuse.

              Results: The screening questionnaire response rate was 71%, the participation rate of the interview 74%. Among 405 people with primary chronic headache, 95% had chronic tension-type headache, 4% had chronic migraine, and <1% had other primary chronic headaches. Of 386 persons with chronic tension-type headache, 44% had medication overuse and 47% had co-occurrence of migraine. Simple analgesics, combination analgesics, triptans, ergotamine, opioids and combination of acute medications were overused by 65%, 27%, 4%, <1%, 1% and 2%, respectively. The mean SDS score was significantly higher in those with than without medication overuse (5.6 vs. 2.7; p<0.001).

              Conclusion: The SDS questionnaire detects medication overuse and dependency-like behaviour in persons with primary chronic headache.

              Key words: Epidemiology; headache; chronic headache; chronic tension-type headache; medication-overuse headache; general population; dependency; SDS

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