Investigators concluded that the increased prevalence of medication-overuse headache might be because of the lack of understanding about the condition in both providers and patients with migraine.
Findings from a survey of patients with migraine and interviews with neurologists indicated that several patients, including those at higher risk, were unaware of medication-overuse headache. These results also suggest that clinicians are more likely to talk about medication-overuse headache with their patients only when a behavior or symptom reminiscent of overuse might be already happening.1
Among 200 patients with migraine, 38.6% claimed they had never heard of 'medication overuse’ for headache. Notably, approximately 53.4% of patients who did hear of medication-overuse headache reported that they had talked about the condition with their current provider and 38.4% learned about the condition 5 or more years following their migraine diagnosis.
“Medication overuse is a common cause of migraine worsening and can lead to increased headache frequency, severity, and reduced effectiveness of acute medication,” lead author Yvonne M. Curran, MD, assistant professor of neurology at Northwestern University and colleagues wrote.1 The results from the survey and interviews were presented at the 2023 American Headache Society (AHS) Annual Meeting, June 15-18, in Austin, Texas.
The mixed methods study included adult patients with migraine and practicing neurologists affiliated with 1 academic health center in Chicago, Illinois. The adult patients were English-speaking, had a diagnosis of migraine, and were enrolled from an electronic health record query. Using the same health system for recruitment, a sample of neurologists were asked by email to participate in an exploratory, qualitative interview that was conducted by trained research staff. The quantitative survey data was assessed using descriptive statistics and the qualitative data from the interviews was analyzed using a modified version of the Rapid Identification of Themes from Audio Recordings (RITA) procedures.
Enrolled patients were contacted through research coordinators that introduced the study to them, engaged them in the informed consent process, and administered the structured survey. Among the 200 adult patients, 82.9% were women, 57.4% were White, 31.8% made less than $50,000 annually, and 18.2% had limited health literacy. The patients had been diagnosed with migraine, on average, for over a decade, with 35.9% of respondents claim they took over-the-counter-pain reliever on at least 15 days in the past month.
“To prevent medication overuse, patients must be aware of how frequently pain relievers can be taken; they also must limit their use of prescription and over-the-counter medications accordingly. Yet few studies have comprehensively examined patient awareness of medication-overuse headache and provider communication about the condition and its causes during clinical encounters,” Curran et al noted.1
In the interviews with neurologists, findings showed that most routinely asked their patients about the medication they use to help determine their potential risk for medication-overuse headache. Most of the neurologists also reported that they would review electronic health record data on their patient’s medication refills depending on if their patients reported symptoms of medication-overuse headache and/or their medication use behavior determined whether and how frequency providers discussed the condition to them.
All of the neurologists reported that patients would rarely, if ever, brought up about the topic of medication-overuse headache on their own. In particularly, 4 neurologists said that their patients would occasionally be surprised and upset if they had not been educated about medication-overuse headache earlier during the course of their migraine management.
Authors noted that neurologists had a reactive approach when providing patients with information about medication-overuse headache after that have or were at risk of the condition. Curran and colleagues also noted that there are opportunities that exist to improve communication between both patients and their providers about medication-overuse headache, the proactively talked condition’s risks in clinical practices.