Evidence Table 4Use of pharmaceutical agents in the treatment of chronic headache

StudyDates and MethodsHeadache DefinitionPopulation Inclusion CriteriaSample SizeResults
Celentano, Stewart, Lipton, et al., 1992

American Migraine Study
11/88–12/88

Mail survey
IHS migraineRepresentative sample of 15,000 US households. Obtained responses from 20,468 people age 12–80.N = 2,422Statistically significant difference by sex (P<0.001) in the use of prescription medications

Migraineurs reported an 80% greater use of prescription medication than subjects with “severe headache”

4.2% of males and 2.9% of females reported no medication use for their headaches

Black migraineurs reported considerably less prescription medication use than whites

Black females were less likely than white women or women from other racial groups to treat their headaches or to use prescription medications.

Use of prescription medication increased with age; increasing from 26.0% of men <30 to 38.6% from 50–59.

Prescription medication use increased among women from 32.9% at <30 to 44.9% at 50–59.

Migraineurs with incomes < $20,000 were less likely than those with higher incomes to use prescription meds (but not significantly so).

Rates of prescription use were highest in the Mountain Region and New England states ·and lowest in Atlantic and North Central Regions

52.3% of women and 38.3% of men with vomiting used prescription medications.

48.1 % of women and 30.2% of men with visual aura used prescription medications.

Level of disability was also related to prescription use, as was duration of attack.
Clarke, MacMillan, Sondhi, et al., 19965/94–6/94

Survey
IHS migraineQuestionnaire mailed to 4,200 employees of the Royal Hull Hospitals Trust (UK). Of the 1,903 surveys returned, 158 (8.3%) were classified as having migraine.N = 15828% used prescription medications, 78% used OTCs

4/158 said they used sumatriptan

8/158 said they were using prophylactic treatment (either propranolol or pizotifen)

13% used alternative therapies such as acupuncture, homeopathy, or yoga
Edmeads, Findlay, Tugwell, et al., 19934/89–4/90

Survey and diary
IHS migraine and tension-typePrevalence Study-Canadians age 15+ were surveyed with random digit dialing. One respondent was selected per household. If there was more than one headache sufferer then the one with the most recent birth date was chosen.Prevalence

N = 1,573
Prevalence study:

Migraineurs- 44% used prescription medication, 91% non-prescription medication, 48% non-medical treatments, 6% preventive medications

Tension-type headache sufferers-24% used prescription medications, 90% non-prescription medications, 34% non-medical treatments, 3% preventive medications

In the interview study prescription medications were prescribed for 62% of those who had seen a physician; at the time of the interview 34% continued to use them. Non-prescription medications recommended for 50%; 25% of these people discontinued treatment.

63% of those interviewed who had never seen a physician also used medication; and 10% of these people who had never seen a physician for their headaches were using prescription medications.

Migraine:

19% of headaches completely relieved by medication

62% of headaches partially relieved by medication

Tension-type headaches:

43% of headaches completely relieved by medication

47% of headaches partially relieved by medication

Migraine and tension-type headache sufferers used medications an average of 3 times per week.

21% of migraineurs and 17% of tension-type headache sufferers used medications more than one time per week
Kryst and Scherl, 1994Spring 1990

Telephone survey
Modified IHS migraineStudy question included as part of the Kentucky Health Survey. Sample households contacted through random digit dialing. Data only primary respondents only included as part of this analysis.N =55 migraine

N =32 serious non-migraine HA
82/87 (94.3%) of serious headache sufferers reported taking medication in the last year

41/82 (50%) used OTC and 35/82 (42.7%) prescription, 6/82 (7.3%) both

29/64 (45.3%) of headache sufferers who reported disabilities took only OTCs

Interference with family relations was strongly associated with use of prescription medication (P=0.05)

Use of prescription drugs was not related to income level or insurance coverage for prescription medications
Linet, Stewart, Celentano, et al., 1989

Migraine Prevalence Study (Washington County Study)
3/86–6/87

Telephone interview and diary study
MigraineWashington County, Maryland residents 12–29 years old. Sample of all households with telephone.N = 10,169

Not all subjects answered all questions
Age12–1718–2324–29
Males8.8%16.2%18.0%
Females10.9%16.8%
Among males, approximately twice as many in the older age groups had taken at least one prescription medication in the last 12 months than in the youngest age groups.

Among females prescription drug use also increased with age.
Lipton and Stewart, 199311/88–12/88

Mail survey
IHS migraineRepresentative sample of 15,000 US households. Obtained responses from 20,468 people age 12–80.N = 2,42295% of severe migraineurs have used some type of medication

Most migraineurs take non-prescription medications rather than prescription

Among women, 56.8% used non-prescription medications, 40.1% used prescription drugs, and 3.1 % take no medications for their headaches

Among men, 66.9% used non-prescription medications, 28.3% used prescription drugs, and 4.8% take no medications for their headaches

43% of men and 34% of women with 3+ headaches per month do not use prescription medication

61 % of men and 47% of women with moderate or severe headache related disability do not use prescription medications
Micieli, Frediani, Cavallini, et al., 19951/90–1/91

Interview
IHS migraine tension-type clusterPatients recruited from the Headache Research Centers of the Neurological Institute of the University of Pavia and the University of Milan. 70% had been referred from general practice and 30% were self referred.N =400Headache Characteristics and Response to Therapy:
TotalEpisodic HA (including migraine)Mixed migraine + tension-type HAChronic tension-type
HA
Analgesic consumption
None7.5%6.98.77.7
Monthly28.033.517.45.8
Weekly46.649.047.836.5
Daily12.78.617.430.8
More than 1/day5.32.08.719.2
Analgesic efficacy
None6.46.64.86.3
Fair44.339.557.160.4
Good49.353.938.133.3
Preventive therapy
None46.847.950.045.5
Fair31.225.025.040.9
Good22.127.125.013.6
Mountstephen and Harrison, 1995Dates unknown

Survey
IHS migraineQuestionnaire distributed to a random sample of 476 employees of a chemical production and research facility. The sample was stratified by age and sex. The overall rate of work absence was validated by the company’s human resources database. There were 423 respondents to the questionnaire; 62 of the 423 were classified as having IHS migraine.N =6210% of migraineurs obtained their medication by prescription

13% used prophylactic medication
Rasmussen, Jensen, and Olesen, 19921/89–7/89

Questionnaire Interview

Physical examination
IHS migraine and tension-typeRandomly selected people, 25–64 years old, living in the western part of Copenhagen county (Denmark).N =74038/77 (49%) with migraine in the previous year used medication in the current year

480/549 (87%) with tension-type headache in the previous year used medication in the current year

31% of migraine and 59% of tension-type headache sufferers used medications with acetylsalicylic acid an average of 1–3 times a month.

Significant correlation between frequency of headache and medication use

17% of migraineurs used ergotamine or dihydroergotamine agents 1–3 times per month

7% used preventive treatment (4% beta-blockers and 3% clonidine)
Von Korff, Galer, and Stang, 19951989–1990

Questionnaire
IHS migrainePatients making headache related visits to primary care provider at Group Health of Puget Sound. Patients were 18–75 years old and had to be continuously enrolled for one year. Patients were excluded if they planned to disenroll or if they did not have a telephone.N =662Percent of headache patients reporting frequent medication use in the previous month:
BaselineOne yearTwo yearsChronic
Prescription18.4%10.310.17.7
Non-Prescription20.119.017.715.9
Poly Pharmacy5.64.73.62.6

Abbreviations: HA =headache; IHS =International Headache Society; NA =not available; OTC =over-the-counter; UK =United Kingdom; US =United States

From: Evidence Tables

Cover of Resource Utilization and Costs of Care for Treatment of Chronic Headache
Resource Utilization and Costs of Care for Treatment of Chronic Headache.
Technical Reviews, No. 2.1.
Archibald N, Lipscomb J, McCrory DC.

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