SAN FRANCISCO — Patients who overused headache medications and had an adverse childhood event were more likely to have a psychiatric diagnosis and use opioids, according to a presenter at the American Headache Society Annual Scientific Meeting.
“We know that [adverse childhood events] are a risk factor for a number of health conditions including migraine ... but risk factors for medication overuse due to headache are not entirely understood,” Claire H. Sandoe, MD, MSc, a headache fellow at Women's College Hospital, University of Toronto, told attendees.
“It may be that the type of medication being used influences the risk for medication overuse for headache. ... We also don’t have a good sense of what the prognostic factors are for patients that develop medication overuse for headache,” she continued.
Sandoe and colleagues examined the relationship between adverse childhood events — neglect, physical or emotional abuse, household dysfunction — and headache medication overuse — having a headache more than 15 days per month for 3 or more months. They assessed the frequency of the adverse childhood events and how such events impacted headache treatment by performing a retrospective chart review of 72 patients with headaches for an average of 10 years, of whom 54% had experienced an adverse childhood event.
Researchers found that the patients with the adverse childhood event were more likely to have a psychiatric diagnosis and use opioids. Patients taking opioids were also less likely to stop overusing their medications.
“These are incredibly disabled patients,” Sandoe said. “The baseline [Migraine Disability Assessment Scores] are astronomically high at 91 and 86 in the respective groups. They also had very frequent or near-daily headache of 25 or 26 days per month, depending on the group.”
Researchers also found that 73% of the patients with an adverse childhood event were likely to have a psychiatric diagnosis vs. 45% of those without such events. Those with an adverse childhood event (32%) were also more likely to overuse opioids vs. those without such events (3%). There were also trends that suggested patients with adverse childhood events were more likely to overuse narcotics at the end of the follow-up period and less improvement in their Migraine Disability Assessment Score.
Sandoe suggested future research and clinical courses of action, based on the findings.
“I had hoped initially to have headache day and headache medication day reporting, but we were unable to in the context of this study. I would also like to extend the study to look at the relapse rates of patients with and without [adverse childhood events],” she said. “We’d also like to ensure that the [Migraine Disability Assessment Score] is a bit more accurate at all of our [patient] visits, and ultimately I’d like to determine if patients with a history of [adverse childhood events] might benefit better from a psychotherapy-based approach.” – by Janel Miller
Sandoe CH, et al. Adverse childhood experience and medication overuse headache: frequency and effects on response to treatment. Presented at: American Headache Society Annual Scientific Meeting; June 28-July 1, 2018; San Francisco.
Sandoe reports no relevant financial disclosures. Healio Family Medicine was unable to determine the other authors’ relevant financial disclosures prior to publication.