Comprehensive Inpatient Treatment of Refractory Chronic Daily 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...

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Bibliographic Details
Published in:Headache 2009-04, Vol.49 (4), p.555-562
Main Authors: Lake III, Alvin E., Saper, Joel R., Hamel, Robert L.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Analgesics - therapeutic use
Biological and medical sciences
Cognitive Therapy - methods
Evidence-Based Dentistry
Female
Follow-Up Studies
Headache Disorders - drug therapy
Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy
Humans
inpatient
Inpatients
intractable headache
Male
Medical sciences
medication overuse headache
Mental Disorders
Middle Aged
Nervous system (semeiology, syndromes)
Neurology
Outcome Assessment (Health Care)
Pain Measurement
personality disorders
psychiatric comorbidity
refractory headache
Retrospective Studies
Treatment Outcome
Vascular diseases and vascular malformations of the nervous system
Young Adult
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Summary: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 
ISSN:0017-8748
1526-4610
DOI:10.1111/j.1526-4610.2009.01364.x