Background
Methods
Design
Patients
Questionnaire elaboration
ICHD-II criteria for probable MOH | Self-questionnaire |
---|---|
A. Headache present on ≥ 15d/month |
1. Do you have headache on ≥ 15 days per month? |
B. Regular overuse for > 3 months |
2. Do you take a treatment for attacks on ≥ 10 days per month?
|
1. Ergotamine, triptans, opioids or combination analgesic medications on ≥ 10 days /month on a regular basis for 3 months |
3. For more than 3 months? |
2. Simple analgesics or any combination of ergotamine, triptans, analgesics opioids on ≥15 D per month on a regular basis for > 3 months |
4. Is this intake on a regular basis?
|
C. Headache has developed or markedly worsened during medication overuse |
Validity assessment and data analysis
Results
Migraine | MOH | P value† | |||
---|---|---|---|---|---|
n = 35 | % | n = 42 | % | ||
Age (years) | 37.4 | 13.6 | 46.7 | 12.2 |
0.003
|
Male | 13.0 | 37.1 | 8.0 | 19.0 |
0.060
|
Female | 22.0 | 62.9 | 34.0 | 81.0 | |
Onset (years) | |||||
< 10 years | |||||
>10 years | 10.0 | 28.6 | 19.0 | 45.2 |
NA
|
25.0 | 71.4 | 23.0 | 54.8 |
NA
| |
Drug intake | |||||
Acetaminophen or NSAID | 2 | 25 | 6 | 17.6 | |
Combination | 2 | 25 | 12 | 20.6 | |
Triptans | 0 | 9 | 35.3 | ||
Ergots opioids | 1 | 12.5 | 0 | 26.5 | |
2 | 25 | 12 | 35.3 |
Question | Sensitivity | Specificity | PPV* | NPV** | ||||
---|---|---|---|---|---|---|---|---|
Absolute values | % | Absolute values | % | Absolute Values | % | Absolute values | % | |
1 | 34/42 | 81.0 | 29/34 | 85.3 | 34/49 | 87.2 | 29/37 | 78.4 |
2
|
40/42
|
95.2
|
26/34
|
76.5
|
40/48
|
83.3
|
26/28
|
92.9
|
3 | 40/41 | 97.6 | 6/33 | 18.2 | 40/67 | 59.7 | 6/7 | 85.7 |
4 | 41/42 | 97.6 | 12/35 | 34.3 | 41/64 | 64.1 | 12/13 | 92.3 |
Yes for each question | ||||||||
1 + 2 | 34/42 | 81.0 | 33/34 | 97.1 | 34/35 | 97.1 | 33/41 | 80.5 |
1 + 4 | 35/43 | 81.4 | 34/35 | 97.1 | 34/35 | 97.1 | 34/42 | 81.0 |
2 + 4
|
40/42
|
95.2
|
28/35
|
80.0
|
40/47
|
85.1
|
28/30
|
93.3
|
1 + 2 + 4 | 34/42 | 81.0 | 35/35 | 100.00 | 34/34 | 100.00 | 35/43 | 81.4 |
Discussion
Patient | Understanding of the question (Yes/No) | Answer to the question |
---|---|---|
n° 1 | Yes | No, because had tried to decrease the intake as early as the worsening of headaches |
n° 2 | Yes | Doesn’t know |
n° 3 | Yes | No |
n° 4 | Yes | Yes |
n° 5 | Yes | Yes |
n° 6 | Yes | No |
n° 7 | Yes | Doesn’t know |
n° 8 | Yes | Yes |
n° 9 | Yes | No |
n° 10 | Yes | No, because already tries to decrease drug consumption |
Author | Country | Population | Questions or criteria | MOH Diagnosis | Type of questionnaire |
---|---|---|---|---|---|
Castillo 1999 | Spain | Random sample 2252 patients | Two questions: | Face-to-face diagnosis by a neurologist interested in headache | Unvalidated Questionnaire |
1- Have you ever had headache? | |||||
2- Do you have headache tend days or more per month? | |||||
Wang 2000 | Taiwan | Population of a small islet > 65 years-old | Revision HIS criteria proposed by Silberstein | Person-to-person survey method and diagnosis by a neurologist | Unvalidated Questionnaire |
Lu 2001 | Taiwan | Random population based survey | Face-to face questionnaire | Then face-to-face diagnosis with a physician | Unvalidated questionnaire |
Headache being present for more than 3 days per week in the previous year | |||||
Colas 2004 | Spain | Quota sampling approach > 14 | Have you ever had headache? | Then face-to-face diagnosis with a physician | Unvalidated questionnaire |
Do you have headache 10 or more days per month? | |||||
If yes, to other questions: In the last three months have you taken any analgesic for your head pain | |||||
Hagen 2009 | Norway | All inhabitants of a county of Norway invited to answer to a questionnaire | Headache more than 14 days per month and use of analgesics 4 times per week or more | Then face to face interview by a neurologist | Validated questionnaire: sensitivity 75%, specificity 100% |
Straube 2010 | Germany | Adults from 3 German regions | 14 single items designed to assess the 2nd ed of IHS, medication overuse classified based on medication intake during the last month. | Face-to-face by trained interviewers | Kappa statistics was calculated: 94.5% indicating excellent inter-rater agreement |
Jonsson 2011 | Sweden | Randomized cluster sampling | Two screening questions: headache present on ≥ 15 days per month and using medication for ≥ 10 days per month during the past three months | Then subsequent interview | Unvalidated questionnaire |