Headache. Common, painful, frustrating, exhausting- and that’s just what the neurologist feels when a headache patient walks in the room. The patients themselves are often at their wits end as headache, whatever the cause, is often functional incapacitating and can really ruin quality of life. Of all the headache types that are seen in neurology, medication-overuse headache (MOH) can be particularly challenging. The condition typically occurs in patients who take frequent large quantities of acute headache treatments, including over-the –counter drugs. The problem here is that these patients often are taking these tablets for another headache condition such as migraine. After taking large amounts of these acute treatments over long periods of time, their migraine symptoms often tend to morph with MOH symptoms and it can be very hard to tell the two apart. Getting patients to cut down on these meds is hard. How do keep patients on the straight and narrow, when as a neurologist, you only see them infrequently?
The answer: involve the GP! In this issue of JNNP, Kristoffersen and colleagues from Norway did just that http://jnnp.bmj.com/content/86/5/505.abstract . They undertook a randomised study in which they asked GPs to undergo further training in how to reduce consumption of drugs related to MOH. Patients were randomised to standard care or to the intervention. The study was successful in that allocation to the intervention improved outcomes in patients with MOH.
MOH is a very common problem and this paper sets out a simple intervention that could make a big difference to the care of these patients.