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Behavioral and Pharmacologic Treatment of Transformed Migraine With Analgesic Overuse: Outcome at 3 Years
Author(s) -
Grazzi Licia,
Andrasik Frank,
D'Amico Domenico,
Leone Massimo,
Usai Susanna,
Kass Steven J.,
Bussone Gennaro
Publication year - 2002
Publication title -
headache: the journal of head and face pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.14
H-Index - 119
eISSN - 1526-4610
pISSN - 0017-8748
DOI - 10.1046/j.1526-4610.2002.02123.x
Subject(s) - medicine , analgesic , migraine , headaches , migraine treatment , biofeedback , pharmacotherapy , anesthesia , drug , chronic migraine , drug treatment , physical therapy , surgery , pharmacology
Objective.—To determine whether combined treatment using medication and biofeedback would be more effective than drug treatment alone for treating transformed migraine complicated by analgesic overuse. Background.—Headaches that are chronic, daily, and aggravated by medication overuse are particularly difficult to treat. Methods.—Sixty‐one consecutive patients with transformed migraine and analgesic overuse were treated with inpatient pharmacologic therapy alone or with inpatient pharmacologic therapy combined with biofeedback‐assisted relaxation. All patients then were followed prospectively for 3 years. Results.—Both treatment groups exhibited similar levels of improvement immediately following treatment and for 1 year thereafter. At year 3, participants receiving combined treatment showed greater sustained improvement on two of three outcome measures assessed (ie, fewer days of headache and reduced consumption of analgesic medication). In addition, a greater number of patients assigned to pharmacologic treatment alone relapsed (ie, resumed overuse of analgesics) compared to patients receiving combined treatment. Conclusions.—These results suggest that a combination of pharmacologic and behavioral treatment is more effective than drug therapy alone in the long‐term management of transformed migraine with analgesic overuse. Confirmation of these findings, as well as extension to other forms of behavioral and cognitive‐behavioral treatment, is required.