NEW YORK (Reuters Health) May 18 - Comprehensive inpatient treatment is effective in the majority of patients with refractory chronic daily headache, according to findings published in the April issue of Headache.
"An evidence-based assessment (2004) concluded that many intractable headache patients benefit from inpatient treatment, and underscored the need for more research, including identification of outcome predictors," Dr. Alvin E. Lake III, and colleagues from Michigan Head-Pain and Neurological Institute, Ann Arbor, write.
The program included intravenous and oral medication programs, withdrawal from overused medications, cognitive behavioral therapy and psychoeducational groups. When needed, patients also received interventional anesthesiology, physical and occupational therapy, and consultation for comorbid conditions. The mean length of stay in the inpatient program was 13 days. Outcome measures included patient-reported pain levels and consensus of medical staff.
A total of 267 patients (212 women and 55 men) from 43 states and Canada completed the program. The mean age of the subjects was 40.3 years. The modal primary diagnosis was intractable chronic daily headache, predominantly migraine (n = 226).
Overall, 158 patients met the criteria for medication overuse headache, primarily involving opioids (n = 127), followed by triptans (n = 39) and ergots (n = 4), and butalbital compounds (n = 28). A total of 115 subjects had both a mood and anxiety disorder. Personality disorders were observed in 70 patients.
Overall, 78% of completers had moderate to significant pain reduction. These patients had comparable improvement in mood, function, and behavior.
The authors report that 84% of patients with medication overuse headache attained moderate to significant improvements in headache control, compared to 69% of non-overusers (p <>
"Comparisons involving the presence or absence of a personality disorder diagnosis found that patients with personality disorders were more often opioid-dependent (62.3% versus 37.7%, p <>Source : http://www.medscape.com/viewarticle/703005?src=mpnews&spon=34&uac=133298AG
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