Disability in Chronic Migraine With Medication Overuse: Treatment Effects at 3 Years


  • Frank Andrasik PhD,

  • Licia Grazzi MD,

  • Susanna Usai MD,

  • Domenico D'Amico MD,

  • Steven Kass PhD,

  • Gennaro Bussone MD

  • From the Department of Psychology, University of West Florida, Pensacola, FL (Drs. Andrasik and Kass); Headache Centre, National Neurological Institute C. Besta, Milan, Italy (Drs. Grazzi, Usai, D'Amico, and Bussone).

Address all correspondence to Dr. Frank Andrasik, Department of Psychology, University of West Florida, 11000 University Parkway, Pensacola, FL 32514, USA.


Objectives.—To determine the clinical status, with respect to pain indices and disability level, of chronic migraine patients with medication overuse who were treated 3 years previously.

Background.—Patients who have chronic migraine accompanied by medication overuse are particularly difficult to treat. Investigations are limited in number, few have included follow-up beyond 6 months, and almost none have examined whether treatment leads to concurrent improvements in disability and functional impairment. In a prior report, we described the clinical course of 84 such patients followed for 1 full year after treatment.

Methods.—These same 84 patients were followed for 2 additional years to assess longer term maintenance of effects, using measurement procedures identical to those in the original investigation.

Results.—Both endpoint and completer analyses revealed significant improvement on all measures studied—headache days per month, analgesic consumption, and MIDAS scores (Total, Headache Frequency, and Headache Intensity)—with some loss of benefits over time for the pain indices. MIDAS total scores, however, were lower at 36 months than at 6 months. Comparisons of those who completed the 3-year follow-up to those who did not revealed few differences at baseline. All of this suggests attrition did not have a bearing on outcome.

Discussion.—High levels of maintenance were revealed at 3 years. Even though reports of pain revealed some lessening of effects, this was not accompanied by reports of deterioration in functioning. This suggests that patients have learned to adapt and adjust to headaches in their daily lives.