The Migraine Research Foundation reports that nearly one in every four households includes someone suffering from migraines. More than just a bad headache, migraines are a severe throbbing pain in one's head that is often accompanied by visual disturbances, nausea, vomiting, and dizziness. The most common solution to this problem is medication to prevent migraines, and/or, to relieve the symptoms.

However a recently published study in BMC Neurology suggests that overmedicating may lead to more serious issues with drug dependency and anxiety. Led by Bruno Biagianti, a post doctoral fellow at the University of California San Francisco Medical Center, the study observed the efficacy of detoxification and medication management education in patients tormented by chronic migraines. Those who struggled to properly manage their medication during the study showed little improvement and weakened mental health.

Detox the Body and Properly Medicate

Using a simple pain medication like aspirin for more than 15 days out of a month, or using stronger prescribed medications for more than 10 days out of a month classifies as medication overuse. Biagianti recruited 63 subjects with chronic migraine with symptomatic medication overuse (CMwMO) for the study. The setup involved first detoxifying the subjects, then monitoring their migraine treatment and management behavior for the following year. The detoxification programmed involved the following:

  • A five day intravenous hydration and steroid injection period
  • A five day oral consumption of steroids
  • Orally consuming a diazepam twice a day during detoxification

Those with far more intense withdrawal symptoms were allowed to take a metoclopramide or indomethacine. At the end of the detoxification program, the subjects were educated on how to manage non-steroidal anti-inflammatory drugs (NSAIDs) for migraine pain relief. The participants were then instructed to document their medication usage in a headache diary for one year.

Biagianti expected some to relapse and return to a state of medication dependence. With the detoxification completed, the following assessment tools were used as baseline variables that could possibly determine the probability of relapse:

  • Migraine Disability Assessment Questionnaire (MIDAS): Measures how much migraines interrupted daily life.
  • Structured Clinical Interviews for DSM-IV-TR (SCID) Axis I Mood Disorders and Axis II Personality Disorders: Assesses mood and personal disorders.
  • Hamilton Rating Scales for Anxiety and Depression (HAM-A, HAM-D): Measures intensity of anxiety and depression symptoms.
  • Pain Locus of Control Scale (PLOC): Measures sense of perceived control over pain and health-related outcomes.
  • Severity of Dependence Scale (SDS): Identifies signs and patterns of medication overuse.
  • Structured Clinical Interview for Substance Use Spectrum (SCI-SUBS): Identifies behavioral patterns associated with substance abuse.

Those Who Relapsed Showed Increased Anxiety

Although none of the assessments could be used to predict relapse in the subjects, the data revealed that 18 subjects had an anxiety or depressive disorder, and all 63 participants reported extremely high rates of headache-related disability and severe dependency-like behaviors. At the end of the yearlong study, 21 subjects did not follow up, 31 did not relapse, and 11 relapsed. Those who did not overmedicate showed significant improvements with:

  • Lower frequencies of headaches
  • Lower MIDAS scores
  • Less intense headache pain
  • Less dependency
  • Less depression symptoms

As for the subjects who unfortunately relapsed, they “did not show any clinical or psychological improvements, instead reported increased anxiety and unmodified perpetuation of severe dependency-like behaviors."

Detoxification and proper education on medication management were successful in reducing the symptoms and severity of migraines. The findings from this study can be used to encourage recovering CMwMO patients to stay on course of their treatment plans, rather than depend on medication to improve their condition.

Date of original publication:
Updated on: October 23, 2015

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