Feasibility of a brief intervention for medication-overuse headache in primary care--a pilot study

Espen Saxhaug Kristoffersen, Jørund Straand, Michael Bjørn Russell, Christofer Lundqvist, Espen Saxhaug Kristoffersen, Jørund Straand, Michael Bjørn Russell, Christofer Lundqvist

Abstract

Background: Medication-overuse headache (MOH) is a common problem in primary care. Brief intervention (BI) has successfully been used for detoxification from overuse of alcohol and drugs. The aim of this pilot study was to develop and test methodology, acceptability and logistics for a BI for MOH in primary care.

Findings: Observational feasibility study of an intervention in a Norwegian general practice population.Six general practitioners (GPs) were recruited. A screening questionnaire for MOH was sent to all 18-50 year old patients on these GPs` list. GPs were taught BI, which was applied to MOH patients as follows: Severity of dependence scale (SDS) scores were collected and individual feedback was given of the relationship between the SDS, medication overuse and headache. Finally, advice to reduce medication was given. Patients were invited to a headache interview three months after the BI. Main outcomes were feedback from GPs/patients about the feasibility and logistics of the study design, screening/recruitment process, BI and headache interviews. Efficacy and patient-related outcomes were not focused. The patients reported a high degree of acceptability of the methodology. The GPs reported the BI to be feasible to implement within a busy practice and to represent a new and improved instrument for communication with MOH patients. The BI requires further testing in a randomised controlled trial (RCT) in order to provide evidence of efficacy.

Conclusion: This feasibility study will be used to improve the BI for MOH and the design of a cluster-RCT.

Trial registration: ClinicalTrials.gov: NCT01078012 (Initially registered as controlled efficacy trial but changed to observational study).

Figures

Figure 1
Figure 1
Flowchart of study. Figure illustrates main time line with the different phases with those mainly responsible for each phase (lower part). Upper part shows time-points for Patients data collection (2 week headache diaries (2w.diary) and interviews) as well as timing of various moments for the Investigator group and GPs with Brief Intervention training courses (BIC) for GPs and intervention. BI, Brief intervention; BIC, Brief Intervention course; GP, General practitioner.
Figure 2
Figure 2
Flowchart of GPs brief intervention for MOH strategy.
Figure 3
Figure 3
Flowchart of the participating patients.

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