Title: Study of Clinical Profile of Patients with Medication Overuse Headache in India
Authors: Debsadhan Biswas, Koustav Jana
DOI: https://dx.doi.org/10.18535/jmscr/v7i6.67
Abstract
Background: Indian data on Medication overuse headache (MOH) is sparse and inadequate. Hence this prospective observational study was conducted.
Aim: To study the socio-demographic and clinical profile of patients with MOH.
Material and Methods: 42 consecutive patients; age ≥ 18 years, fulfilling the diagnostic criteria of MOH according to ICDH-3 Beta were enrolled in the study from Neurology OPD between March 2017 to April 2019 after excluding patients with secondary causes of headache and those who denied consent. Socio-demographic and clinical data of those were recorded using a pre-designed proforma and analyzed using descriptive statistics.
Results: The study revealed female predominance (85.7%) among the study subjects with a mean age of 34.7 years; most (40.5%) were between 31-40 years of age. Most of the patients received education up to primary (30.9%) or secondary level (40.5%) and were from the lower (26.2), upper lower (45.2%) or the lower middle (21.4%) socio-economic class. Migraine (54.7%) was the most common primary underlying headache type, followed by Tension type headache (40.5%); mean duration of headache being 4.5 years. Most common overused medication was non-opioid containing combination analgesics (50%). 11.9% patients were obese and 33.3% were overweight; 19% fulfilled the WHO criteria for inactivity. Prior stressful life event was found in 11.9% patients, chronic musculoskeletal pain in 23.8% and sleep disturbances in 80.9% patients. 73.8% patients suffered from depression while 57.1% suffered from anxiety. 64.3% had a prior visit to a qualified physician for headache. None of the patients maintained a headache diary and none were cautioned previously against medication overuse.
Conclusion: Along with low educational and socio-economic status, easy availability of over-the-counter pain medications, lack of awareness regarding their overuse contribute to MOH in Indian scenario.
Keywords: Medication overuse headache, MOH.
References
- Ravishankar K. Medication overuse headache in India. Cephalalgia. 2008;28(11):1223-6.
- Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version).2013;33(9):629-808.
- Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta psychiatric scandinavica. 1983 Jun 1;67(6):361-70.
- WHO Expert Committee on Physical Status: the Use and Interpretation of Anthropometry (1993: Geneva, Switzerland) & World Health Organization. (1995). Physical status: the use of and interpretation of anthropometry, report of a WHO expert committee. World Health Organization.
- Bull FC, Armstrong TP, Dixon T, Ham S, Neiman A, Pratt M. Physical inactivity. In: Ezzati M, Lopez AD, Rodgers A, Murray CJL, eds. Comparative quantification of health risks. Global and regional burden of disease attributable to selected major risk factors. Geneva: World Health Organization, 2004: 729–881.
- Agarwal N. Study of Clinical Profile of Patients with Medication Overuse Headache. IOSR J Dent Med Sci (IOSR-JDMS). 2017; 16.11: 38-41.
- Imai N, Kitamura E, Konishi T, Suzuki Y, Serizawa M & Okabe T. Clinical features of probable medication-overuse headache: a retrospective study in Japan. Cephalalgia. 2007; 27:1020–1023.
- Radat F, Creac’h C, Guegan‐Massardier E, Mick G, Guy N, Fabre N, Giraud P, Nachit‐Ouinekh F, Lantéri‐Minet M. Behavioral dependence in patients with medication overuse headache: A cross‐sectional study in consulting patients using the DSM‐IV criteria. Headache: The Journal of Head and Face Pain. 2008 Jul;48(7):1026-36.
- Westergaard et al.: EHMTI-0145. Health risk behaviours in medication-overuse headache: results of a population based study. The Journal of Headache and Pain 2014 15(Suppl 1):B38.
- Hagen et al.: Risk factors for MOH and chronic daily headache: an 11-year follow-up study. The Nord-Trøndelag Health Studies (HUNT). The Journal of Headache and Pain 2013 14(Suppl 1):P13.