Programme no. 227-OP
BRIEF INTERVENTION FOR MEDICATION-OVERUSE HEADACHE IN PRIMARY CARE (THE BIMOH STUDY) – AN OPEN LONG-TERM FOLLOW-UP
Espen Saxhaug Kristoffersen*1, Michael Bjørn Russell2, Christofer Lundqvist3, Jørund Straand4
1Department of General Practice,University Of Oslo,Oslo,Norway, 2Head and Neck Research Group,Akershus University Hospital,Lørenskog,Norway, 3Research Centre,Akershus University Hospital,Lørenskog,Norway, 4Department of General Practice,University Of Oslo,Oslo,Norway
* = Presenting author
Objectives: To evaluate the long-term effectiveness of BI for MOH in primary care.
Background: Medication-overuse headache (MOH) is a common health problem associated with non-constructive use of pain medication. Most MOH patients overuse simple analgesics and are managed in primary care. Withdrawal of the overused medication is the treatment of choice in MOH. Brief Intervention (BI) has been used as a motivational technique for patients with alcohol overuse, and may have a role in the treatment of MOH.
Responder rate after two reminders was 42% for the screening questionnaire.
A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study at baseline. 57 patients were followed-up after one year. Analyses of the outcomes showed that BI was better than BAU with significant improvements only in the BI group at three months which persisted up to 12 months.
More results are currently being analysed and will be presented at the meeting.
This was a double-blind pragmatic cluster randomised parallel controlled trial in primary care in Norway. Fifty GPs were randomised to receive BI training or to continue their business as usual (BAU). 25 486 patients aged 18-50 years from the GPs lists were screened for MOH by a questionnaire. Patients were cluster randomised and received treatment by their GP. GPs practising BI assessed their MOH patients using the Severity of Dependence Scale (SDS). Based on this, the patients received feedback about the risk of MOH, and recommendations for reducing intake of headache medication.
In the blinded part of the study, patients were followed-up after three months with a clinical interview and examination. A new telephone interview was conducted after six months. After the six months follow-up, GPs in the BAU group were taught BI and most of the patients in the BAU group also received BI. Thus, the last part of the follow-up was an open study and outcomes were assessed after 12 months
Conclusion: BI intervention for MOH conducted in primary care has significant effects lasting over twelve months.
Points for discussion:
BI for MOH lasting effects over 12 months?
Predictors of successful detoxification after BI for MOH?
BI for MOH a feasible strategy in general practice?