RT Journal Article
SR Electronic
T1 Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 505
OP 512
DO 10.1136/jnnp-2014-308548
VO 86
IS 5
A1 Espen Saxhaug Kristoffersen
A1 Jørund Straand
A1 Kjersti Grøtta Vetvik
A1 Jūratė Šaltytė Benth
A1 Michael Bjørn Russell
A1 Christofer Lundqvist
YR 2015
UL http://jnnp.bmj.com/content/86/5/505.abstract
AB Background Medication-overuse headache (MOH) is common in the general population. We investigated effectiveness of brief intervention (BI) for achieving drug withdrawal in primary care patients with MOH. Methods The study was double-blind, pragmatic and cluster-randomised controlled. A total of 25 486 patients (age 18–50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and were randomised to receive BI training (23 GPs) or to continue business as usual (BAU; 27 GPs). The Severity of Dependence Scale was applied as a part of the BI. BI involved feedback about individual risk of MOH and how to reduce overuse. Primary outcome measures were reduction in medication and headache days/month 3 months after the intervention and were assessed by a blinded clinical investigator. Results 42% responded to the postal screening questionnaire, and 2.4% screened positive for MOH. A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study. BI was significantly better than BAU for the primary outcomes (p<0.001). Headache and medication days were reduced by 7.3 and 7.9 (95% CI 3.2 to 11.3 and 3.2 to 12.5) days/month in the BI compared with the BAU group. Chronic headache resolved in 50% of the BI and 6% of the BAU group. Conclusions The BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH. Trial registration number NCT01314768.