Chronic daily headache with medication overuse: predictors of outcome 1 year after withdrawal therapy

Background and purpose:  We examined prospectively the results of withdrawal therapy in 80 patients with probable medication overuse headache. The aim was to identify baseline patient characteristics that might predict outcome after 1 year (end of study). Methods:  We classified patients according to results of withdrawal therapy measured as the improvement of headache days (HD) from baseline to end of study. Results:  Thirty-six per cent (29/80) had at least 50% improvement. Sixty-four per cent (51/80) had <50% improvement, and among these, 30% (24/80) had <10% improvement. The following baseline characteristics were associated with poor outcome of withdrawal therapy: use of codeine-containing drugs, low self-reported sleep quality, and high self-reported bodily pain as measured by the quality of life tool SF-36. Conclusion:  Before suggesting withdrawal therapy, one should probably pay more close attention to sleep problems.