Mathematical symbols: χ2 = chi square; F = F value (analysis of variance); t = Student's t test (independent samples); P = probability.
Comprehensive Inpatient Treatment of Refractory Chronic Daily Headache
Article first published online: 25 FEB 2009
© 2009 the Authors. Journal compilation © 2009 American Headache Society
Headache: The Journal of Head and Face Pain
Volume 49, Issue 4, pages 555–562, April 2009
How to Cite
Lake, A. E., Saper, J. R. and Hamel, R. L. (2009), Comprehensive Inpatient Treatment of Refractory Chronic Daily Headache. Headache: The Journal of Head and Face Pain, 49: 555–562. doi: 10.1111/j.1526-4610.2009.01364.x
Conflict of Interest: None
- Issue published online: 25 MAR 2009
- Article first published online: 25 FEB 2009
- Accepted for publication January 7, 2009.
- intractable headache;
- medication overuse headache;
- personality disorders;
- psychiatric comorbidity;
- refractory headache
Objective.— (1) To assess outcome at discharge for a consecutive series of admissions to a comprehensive, multidisciplinary inpatient headache unit; (2) To identify outcome predictors.
Background.— An evidence-based assessment (2004) concluded that many refractory headache patients appear to benefit from inpatient treatment, underscoring the need for more research, including outcome predictors.
Methods.— The authors completed a retrospective chart review of 283 consecutive admissions over 6 months. The inpatient program (mean length of stay = 13.0 days) included intravenous and oral medication protocols, drug withdrawal when indicated, cognitive-behavior therapy, and other services when needed, including anesthesiological intervention. Patient-reported pain levels and consensus of medical staff determined outcome status.
Results.— The 267 completers (94%) included 212 women and 55 men (mean age = 40.3 years, range = 13-74) from 43 states and Canada. The modal diagnosis was intractable, chronic daily headache (85%), predominantly migraine. Most (59%) had medication overuse headache (MOH), involving opioids (48%), triptans (16%), or butalbital-containing analgesics (10%). Psychiatric diagnoses included stress-related headache (82%), mood disorders (70%), anxiety disorders (49%), and personality disorders (PD, 26%). More patients with a PD (62%) had opioid-related MOH than those with no PD (38%), P < .005. Of the completers, 78% had moderate to significant pain reduction, with comparable improvement in mood, function, and behavior. Clinical factors predicting moderate-significant headache improvement were limited to MOH (84% vs 69%, P < .007) and presence of a PD (68% vs 81%, P < .03).
Conclusions.— Most patients (78%) improved following aggressive, comprehensive inpatient treatment. Maintenance of improvement is likely to depend on multiple post-discharge factors, including continuity of care, compliance, and home or work environment.