Patients who rely on medication may experience increased anxiety according to a recent study. Can a combination of detoxification and psychoeducation help combat addictions effects? The Migraine Research Foundation reports that 25% of households have at least one person suffering from migraines. Migraines go beyond being severe headaches; they involve intense throbbing pain in the head often accompanied by visual disturbances, nausea, vomiting and dizziness. Medication is commonly used either for prevention or symptom relief.
However a study published in BMC Neurology suggests that excessive reliance on medication may lead to serious problems such as drug dependency and anxiety. Led by Bruno Biagianti, a fellow at the University of California San Francisco Medical Center the study examined the effectiveness of detoxification and education about proper medication management in patients dealing with chronic migraines. Those who struggled with managing their medication during the study showed minimal improvement and experienced deteriorating mental health.
Properly detoxifying the body and using medications as prescribed are factors. Using over the counter pain relievers like aspirin for than 15 days per month or relying on stronger prescribed medications for more than 10 days per month falls under medication overuse. For this study Biagianti recruited 63 participants, with migraines combined with symptomatic medication overuse (CMwMO).To conduct the study the initial step involved detoxifying the participants and then monitoring their behavior in managing and treating migraines for the year. The detoxification process consisted of the steps;
- Administering intravenous hydration and steroid injections over a period of five days.
- Taking steroids for five days.
- Consuming diazepam twice a day during detoxification.
- Participants experiencing withdrawal symptoms were allowed to take metoclopramide or indomethacine.
Once the detoxification program was completed participants received education on managing migraine pain relief using steroidal anti inflammatory drugs (NSAIDs). They were then instructed to maintain a headache diary documenting their medication usage for one year.
The researcher, Biagianti anticipated that some participants might relapse and revert to relying on medication. After completing detoxification several assessment tools were used as baseline measures to determine the likelihood of relapse;
- Migraine Disability Assessment Questionnaire (MIDAS); Evaluates how much migraines disrupt life.
- Structured Clinical Interviews for DSM IV TR (SCID) Axis I Mood Disorders and Axis II
- Personality Disorders; Assesses mood and personality disorders.
- Hamilton Rating Scales, for Anxiety and Depression (HAM A, HAM D); Measures the intensity of anxiety and depression symptoms.
Pain Locus of Control Scale (PLOC)
The study aimed to understand the perceived control over pain and health related outcomes. Two assessment tools were used; the Severity of Dependence Scale (SDS) to identify signs of medication overuse and the Structured Clinical Interview for Substance Use Spectrum (SCI SUBS) to identify patterns related to substance abuse. Although none of these assessments could predict relapse in the subjects the data showed that 18 participants had anxiety or depressive disorders. All 63 participants reported rates of headache related disability and behaviors indicative of severe dependency. At the end of the year study 21 participants did not follow up 31 did not relapse and 11 relapsed.
Among those who did not overmedicate significant improvements were observed;
- Reduced frequency of headaches
- Lower MIDAS scores
- intense headache pain
- Reduced dependency
- Fewer symptoms of depression
In contrast participants who unfortunately relapsed did not show any clinical or psychological improvements. Instead they reported increased anxiety and continued severe dependency like behaviors.
Detoxification and proper education on medication management proved successful in reducing symptoms and severity. These findings can encourage individuals recovering from Chronic Migraine with Medication Overuse (CMwMO) to stick to their treatment plans of relying solely on medication, for improvement.
Reference; Biagianti, B., Grazzi, L., Usai, S. & Gambini, O. (2014). Dependency like. Coping strategies for pain in individuals with chronic migraine and excessive medication use; findings, from a one year follow up investigation. BMC Neurology. DOI; 10.1186/s12883 014 0181 4
Carla Nasca, Ph.D., is a post-doctoral fellow of the American Foundation for Suicide Prevention in the laboratory of Neuroendocrinology at the Rockefeller University, New York. Dr. Nasca received her B.A. in Molecular Biology and her M.S. in Electrophysiology from the University of Palermo in Italy. She earned her Ph.D. in Neurobiology and Pharmacology from the University Sapienza in Rome, Italy, before moving to The Rockefeller University under the mentorship of Dr. Bruce McEwen.