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Behavioral and Pharmacologic Treatment of Transformed Migraine With Analgesic Overuse: Outcome at 3 Years


  • Reprint requests should be addressed to Dr. Licia Grazzi, Headache Center, National Neurological Institute C. Besta, Via Celoria 11, 20133 Milan, Italy.

Address all correspondence to Dr. Frank Andrasik, Institute for Human and Machine Cognition, University of West Florida, 40 South Alcaniz Street, Pensacola, FL 32501.


Objective.—To determine whether combined treatment using medication and biofeedback would be more effective than drug treatment alone for treating transformed migraine complicated by analgesic overuse.

Background.—Headaches that are chronic, daily, and aggravated by medication overuse are particularly difficult to treat.

Methods.—Sixty-one consecutive patients with transformed migraine and analgesic overuse were treated with inpatient pharmacologic therapy alone or with inpatient pharmacologic therapy combined with biofeedback-assisted relaxation. All patients then were followed prospectively for 3 years.

Results.—Both treatment groups exhibited similar levels of improvement immediately following treatment and for 1 year thereafter. At year 3, participants receiving combined treatment showed greater sustained improvement on two of three outcome measures assessed (ie, fewer days of headache and reduced consumption of analgesic medication). In addition, a greater number of patients assigned to pharmacologic treatment alone relapsed (ie, resumed overuse of analgesics) compared to patients receiving combined treatment.

Conclusions.—These results suggest that a combination of pharmacologic and behavioral treatment is more effective than drug therapy alone in the long-term management of transformed migraine with analgesic overuse. Confirmation of these findings, as well as extension to other forms of behavioral and cognitive-behavioral treatment, is required.