Migraine and Headache Studies
Open access
Peer reviewed
Abstract
Abstract
Background/Objective: Medication overuse headache (MOH) is a disabling secondary headache disorder that arises from an underlying primary headache, most commonly migraine. Although treatment reduces headache frequency and medication overuse, the interictal burden—the impact experienced between headache attacks—remains poorly characterized over the long term. This study evaluated interictal burden and clinical outcomes two years after MOH diagnosis. Methods: This study was derived from a prospective multicenter cohort of patients with MOH, using data from a single center. Of 149 patients enrolled between April 2020 and November 2022, 117 (78.5%) completed the two-year follow-up. Clinical characteristics, medication overuse, monthly headache days, and standardized questionnaires were assessed at baseline and follow-up. Interictal burden was evaluated at two years using the Migraine Interictal Burden Scale (MIBS-4), with scores ≥5 indicating severe burden. Results: At baseline, patients (81.2% female; median age, 45.0 years) reported a median of 16.0 monthly medication days (interquartile range, 13.0–23.0). Medication overuse decreased from 100% at baseline to 24.2% at one year and 17.1% at two years. Among 117 patients with available two-year MIBS-4 data, 25 (21.4%) had severe interictal burden. Compared with those without severe burden, these patients had greater headache-related impact and disability (HIT-6: 68.0 vs. 64.0, p = 0.019; MIDAS: 110.0 vs. 36.0, p = 0.002), higher psychological burden (PHQ-9: 11.0 vs. 8.0, p = 0.032; GAD-7: 7.0 vs. 4.0, p = 0.010), and were more likely to be current smokers (20.0% vs. 4.3%, p = 0.036). Notably, 14.4% of patients with resolved medication overuse still reported severe interictal burden. Conclusions: Two years after MOH diagnosis, severe interictal burden was observed in a substantial proportion of patients and was associated with greater baseline disability and psychological distress. These findings highlight the need for long-term monitoring and management beyond initial medication withdrawal.
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@article{Hong2026Year,
title = {Two-Year Outcomes and Interictal Burden After Treatment for Medication Overuse Headache},
author = {Yooha Hong and Mi‐Kyoung Kang and Soo‐Jin Cho},
journal = {Journal of Clinical Medicine},
year = {2026},
doi = {10.3390/jcm15124785},
url = {https://doi.org/10.3390/jcm15124785}
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