We studied the effects of short-term psychodynamic psychotherapy (STPP) and pharmacological therapy in 26 consecutive patients with probable medication overuse headache (pMOH). Patients underwent a standard in-patient detoxification protocol, lasting a mean of 7 days. Eleven patients overused non-steroidal anti-inflammatory drugs (NSAIDs), five a combination of NSAIDs and triptans, four triptans, four a combination of NSAIDs, and three triptans and ergot derivates. Preventive therapy was initiated during detoxification. The STPP protocol comprised the Brief Psychodynamic Investigation (BPI) and psychoanalysis-inspired psychotherapy. All patients (groups A and B) underwent the BPI and pharmacological therapy. Half of the patients (group B) also not randomly underwent psychoanalysis-inspired psychotherapy. We found a significant interaction between time and group for headache frequency and medication intake. At 12-month follow-up, a statistically greater decrease in headache frequency and medication intake was observed in group B than in group A (P = 0.0108 and P = 0.0097, respectively). The relapse rate was much lower in group B patients at both 6 and 12 months [15.3%, odds ratio (OR) 0.11, P = 0.016, and 23%, OR 0.18, P = 0.047, respectively] than in group A. The risk of developing chronic migraine (CM) during follow-up was higher in group A than in group B at 6 (OR 2.0, P = 0.047) and 12 months (OR 2.75, P = 0.005). Our study suggests that STPP in conjunction with drug withdrawal and prophylactic pharmacotherapy relieves headache symptoms in pMOH, reducing both long-term relapses and the burden of CM.

Combined pharmacological and short-term psychodynamic psychotherapy for probable medication overuse headache: a pilot study / Altieri, M.; Giambattista, R.; DI CLEMENTE, Laura; Fagiolo, D.; Tarolla, E.; Mercurio, A.; Vicenzini, E.; Tarsitani, L.; Lenzi, Gian Luigi; Biondi, Massimo; DI PIERO, Vittorio. - In: CEPHALALGIA. - ISSN 0333-1024. - 29:3(2009), pp. 293-299. [10.1111/j.1468-2982.2008.01717.x]

Combined pharmacological and short-term psychodynamic psychotherapy for probable medication overuse headache: a pilot study

DI CLEMENTE, Laura;D. Fagiolo;E. Tarolla;L. Tarsitani;LENZI, Gian Luigi;BIONDI, Massimo;DI PIERO, Vittorio
2009

Abstract

We studied the effects of short-term psychodynamic psychotherapy (STPP) and pharmacological therapy in 26 consecutive patients with probable medication overuse headache (pMOH). Patients underwent a standard in-patient detoxification protocol, lasting a mean of 7 days. Eleven patients overused non-steroidal anti-inflammatory drugs (NSAIDs), five a combination of NSAIDs and triptans, four triptans, four a combination of NSAIDs, and three triptans and ergot derivates. Preventive therapy was initiated during detoxification. The STPP protocol comprised the Brief Psychodynamic Investigation (BPI) and psychoanalysis-inspired psychotherapy. All patients (groups A and B) underwent the BPI and pharmacological therapy. Half of the patients (group B) also not randomly underwent psychoanalysis-inspired psychotherapy. We found a significant interaction between time and group for headache frequency and medication intake. At 12-month follow-up, a statistically greater decrease in headache frequency and medication intake was observed in group B than in group A (P = 0.0108 and P = 0.0097, respectively). The relapse rate was much lower in group B patients at both 6 and 12 months [15.3%, odds ratio (OR) 0.11, P = 0.016, and 23%, OR 0.18, P = 0.047, respectively] than in group A. The risk of developing chronic migraine (CM) during follow-up was higher in group A than in group B at 6 (OR 2.0, P = 0.047) and 12 months (OR 2.75, P = 0.005). Our study suggests that STPP in conjunction with drug withdrawal and prophylactic pharmacotherapy relieves headache symptoms in pMOH, reducing both long-term relapses and the burden of CM.
2009
medication overuse headache; chronic migraine; pharmacological treatment; psychiatric comorbidity; short-term psychodynamic psychotherapy
01 Pubblicazione su rivista::01a Articolo in rivista
Combined pharmacological and short-term psychodynamic psychotherapy for probable medication overuse headache: a pilot study / Altieri, M.; Giambattista, R.; DI CLEMENTE, Laura; Fagiolo, D.; Tarolla, E.; Mercurio, A.; Vicenzini, E.; Tarsitani, L.; Lenzi, Gian Luigi; Biondi, Massimo; DI PIERO, Vittorio. - In: CEPHALALGIA. - ISSN 0333-1024. - 29:3(2009), pp. 293-299. [10.1111/j.1468-2982.2008.01717.x]
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