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NCT Number: NCT02903329

Comparison of Two Detoxification Protocols for Treatment of Medication-overuse Headache

Medication-overuse headache (MOH) is a common, costly and disabling disorder affecting approximately 63 million people worldwide. MOH is a potentially treatable condition, and there are different opinions among headache specialists concerning the correct treatment strategy.

The study is a prospective longitudinal open-label randomized controlled study comparing two detoxification programs conducted in a tertiary headache care center. Patients with MOH are either randomized to treatment in program A or program B. In program A, patients undergo detoxification without any acute medication during a two months period (complete stop of acute medication intake). In program B, patients was allowed to take up to 2 days a week with analgesics or migraine medication during the two months detoxification period (restricted acute medication intake). Both A and B are out-patient programs, and patients in both groups receive patient education, consisting of six lessons, managed by specialized headache nurses in collaboration with specialized psychologists and physiotherapists (Figure 1). All patients are also offered rescue medication (levomepromazine or promethazine) and antiemetics, if necessary.

The need for prophylactic treatment is evaluated individually after 2-month detoxification. Patients are followed-up at 2, 6 and 12 months after detoxification. All patients are asked to continuously register headache calendar and to fulfill questionnaires at all the follow-up visits. In addition they are asked to fill out questionnaires (Headache Under-Response to Treatment (HURT), Hospital Anxiety and Depression Score (HADS), Severity of Dependence Score (SDS), World Health Organization Quality of Life Score(WHO QoL) and Dolo-score) at baseline, 2, 6 and 12 months

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Key information

Conditions

Medication-overuse Headache Brain Diseases Central Nervous System Diseases Headache Disorders Headache Disorders, Secondary Nervous System Diseases

Age range

18 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Danish Headache Center

Glostrup Municipality, Copenhagen, 2600, Denmark

About this study

Patients with contact to Danish headache center are recruited consecutively. The MOH-diagnosis is based on least 3 months previous detailed history and at least 1 month fulfilled headache diary or headache calendar prior to the visit.

Patients were allocated to either program A or B by a concealed randomization process. The patients were randomized in blocks of 10 by use of opaque, sealed envelopes.

Statistics Statistical Package for Social Sciences (SPSS) version 22 is used for statistical calculations. Continuous variables are presented as mean (SD) and median (25-75 percentiles). For normal distributed continuous variables the investigators use paired and unpaired student's T-test, while for skewed distribution the investigators used Mann-Whitney test. Categorical variables is presented as percentage (N), and analyzed by chi-square test. All results are shown as intention-to-treat (ITT). The p-value is two-sided and p ≤ 0.05 is considered as significant.

The primary outcome is reduction in headache days per month. Clinical relevant difference is estimated to 20% between the two groups. The standard deviation based on previous published literature was estimated to 35%. Accepting an alfa-error on 5% and 80% power, 80 patients are needed. Based on previous studies, it is assumed that the drop-out rate will be approximately 15-20%. Therefore the investigators aim to include 100 patients corresponding to 50 in each group.

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • MOH-diagnosis according to ICHD-3beta
  • Eligible for out-patient care
  • Previously diagnosed with primary headache forms.

Exclusion criteria

  • Previously diagnosed with secondary headache forms
  • Significant physical or psychiatric illness
  • Pregnancy or breastfeeding
  • Inadequate language skills to follow the patient education and filling out questionnaires.

Treatment and study plan

Detoxification

Other

Two ways of composing the detoxification protocol

Other names: Treatment for MOH

Primary outcomes

  1. Headache frequency

    Time frame: 6 months

Secondary outcomes

  1. Days with acute medication/ month

    Time frame: 6 and 12 month

  2. Headache frequency

    Time frame: 12 months

  3. Headache intensity (Total intensity per month meassured by headache calendars).

    Time frame: 6 and 12 months

    Patients daily register headache intensity by 0,1, 2 or 3 corresponding to the intensity. The headache intensity is summed up for 30 days.

  4. Scores from questionnaires Headache Under-Response to Treatment (HURT)

    Time frame: 6 and 12 months

  5. Scores from questionnaires Hospital Anxiety and Depression Score (HADS)

    Time frame: 6 and 12 months

  6. Scores from questionnaires World Health Organization Quality of Life score

    Time frame: 6 and 12 months

  7. Scores from questionnaires Severity of Dependence Score (SDS)

    Time frame: 6 and 12 months

  8. Scores from questionnaires Dolo-score

    Time frame: 6 and 12 months

Sponsors and collaborators

Lead sponsor

Danish Headache Center

Other

Registry information

Official study title

Efficacy of Restricted Acute Medication Intake Compared to no Acute Medication Intake During a Two Months Detoxification Period in Medication-overuse Headache

Acronym: MUM

Important dates

Study start
2013
Primary completion
2017
Study completion
2017
First posted
Sep 16, 2016
Registry last updated
Jul 24, 2018

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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