Factors associated with a negative outcome of medication-overuse headache: A 3-year follow-up (the 'CARE' protocol)

Aim: To evaluate factors associated with a negative outcome in a 3-year follow-up of subjects diagnosed with medicationoveruse headache (MOH) (revised-ICHD-II criteria). Methods: All consecutive patients entering the centers inpatient detoxification program were analyzed in a prospective, non-randomized fashion. All participants were assessed by a neurologist using an ad hoc patient record form. Personality was assessed using the Minnesota Multiphasic Personality Inventory (MMPI)-2, Chi-square test, one-way analysis of variance (ANOVA), and odds ratios (OR) were calculated as appropriate. Results: One-hundred and fifty patients completed the follow-up (79.3% females, age 46.40±11.31 years): 13 never stopped their drug overuse (A), 38 stopped their overuse, but relapsed at least once (B), and 99 stopped and never relapsed (C). The Group A patients differed from those in B+C as they were more frequently single (OR 0.134; p0.007) and unemployed (OR 3.273; p0.04), took a higher number of drug doses (p≤0.001), and less frequently drank coffee (OR 3.273; p0.044). Personality profile: subjects in A scored higher than those in C on the following scales: Hypochondriasis (p0.007), Depression (p0.003), Paranoia (p0.025), Fears (p0.003), Obsessiveness (p0.026), Bizarre Mentation (p0.046), Social Discomfort (p0.004), Negative Treatment Indicators (p0.040), Repression (p0.007), Overcontrolled Hostility (p0.040), Addiction Admission (p0.021), Social Responsibility (p0.039), and Marital Distress (p0.028). Conclusion: Disease outcome in MOH patients is influenced negatively by overuse severity and by specific psychological and socio-economic variables. Other possible modifier factors were voluptuary habits.