HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) CME: Take the course for this article: Volume 61, Number 2, July 22, 2003 Correspondence: Submit a response Correspondence: View responses Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zwart, J.-A. Articles by Holmen, J. Search for Related Content PubMed PubMed Citation Articles by Zwart, J.-A. Articles by Holmen, J. Related Collections All Headache Migraine All Pain

Analgesic use: A predictor of chronic pain and medication overuse headache

The Head–HUNT Study

From the Department of Clinical Neuroscience (Drs. Zwart and Hagen), Section of Neurology, Department of Psychiatry and Behavioural Medicine (Drs. Dyb and Svebak), and HUNT Research Centre (Dr. Holmen), Faculty of Medicine, Norwegian University of Science and Technology, Trondheim.

Address correspondence and reprint requests to Dr. J.-A. Zwart, Department of Clinical Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, 7006 Trondheim, Norway; e-mail: john-anker.zwart{at}medisin.ntnu.no

Objective: To examine the relation between analgesic use at baseline and the subsequent risk of chronic pain (15 days/month) and the risk of analgesic overuse.

Methods: In total, 32, 067 adults reported the use of analgesics in 1984 to 1986 and at follow-up 11 years later (1995 to 1997). The risk ratios (RR) of chronic pain and RR of analgesic overuse in the different diagnostic groups (i.e., migraine, nonmigrainous headache, neck pain, and low-back pain) were estimated in relation to analgesic consumption at baseline.

Results: Individuals who reported use of analgesics daily or weekly at baseline showed significant increased risk for having chronic pain at follow-up. The risk was most evident for chronic migraine (RR = 13.3, 95% CI: 9.3 to 19.1), intermediate for chronic nonmigrainous headaches (RR = 6.2, 95% CI: 5.0 to 7.7), and lowest for chronic neck (RR = 2.4, 95% CI: 2.0 to 2.8) or chronic low-back (RR = 2.3, 95% CI: 2.0 to 2.8) pain. Among subjects with chronic pain associated with analgesic overuse, the RR was 37.6 (95% CI: 21.3 to 66.4) for chronic migraine, 14.4 (95% CI: 10.4 to 19.9) for chronic nonmigrainous headaches, 7.1 for chronic neck pain (95% CI: 5.5 to 9.2), and 6.4 for chronic low-back pain (95% CI: 4.9 to 8.4). The RR for chronic headache (migraine and nonmigrainous headache combined) associated with analgesic overuse was 19.6 (95% CI: 14.8 to 25.9) compared with 3.1 (95% CI: 2.4 to 4.2) for those without overuse.

Conclusion: Overuse of analgesics strongly predicts chronic pain and chronic pain associated with analgesic overuse 11 years later, especially among those with chronic migraine.

This article has been cited by other articles:

				K. Paemeleire, A. Bahra, S. Evers, M. S. Matharu, and P. J. Goadsby Medication-overuse headache in patients with cluster headache. Neurology, July 11, 2006; 67(1): 109 - 113. [Abstract] [Full Text] [PDF]

				V. K. Gupta Orbitofrontal cortex hypometabolism, medication overuse headache, substance abuse and migraine: key pathophysiological issues. Brain, July 1, 2006; 129(Pt 7): E52 - E52. [Full Text] [PDF]

				A. Fumal, R. Kupers, and J. Schoenen Reply: Orbitofrontal cortex hypometabolism, medication overuse headache, substance abuse and migraine: key pathophysiological issues Brain, July 1, 2006; 129(7): E53 - E53. [Full Text] [PDF]

				G. Dyb, T. L. Holmen, and J.-A. Zwart Analgesic overuse among adolescents with headache: The Head-HUNT-Youth Study Neurology, January 24, 2006; 66(2): 198 - 201. [Abstract] [Full Text] [PDF]

				D. W. Dodick Chronic Daily Headache N. Engl. J. Med., January 12, 2006; 354(2): 158 - 165. [Full Text] [PDF]

				J. G. Millichap Medication Overuse Worsens Chronic Daily Headache AAP Grand Rounds, November 1, 2005; 14(5): 55 - 55. [Full Text] [PDF]

				J. -A. Zwart, G. Dyb, K. Hagen, S. Svebak, L. J. Stovner, and J. Holmen Analgesic overuse among subjects with headache, neck, and low-back pain Neurology, May 11, 2004; 62(9): 1540 - 1544. [Abstract] [Full Text] [PDF]

				J. Whitall Stroke Rehabilitation Research: Time to Answer more Specific Questions? Neurorehabil Neural Repair, March 1, 2004; 18(1): 3 - 8. [PDF]

				F. D. Sheftell, S. J. Tepper, A. M. Rapoport, J.-A. Zwart, G. Dyb, K. Hagen, S. Svebak, and J. Holmen Analgesic use: A predictor of chronic pain in medication overuse headache: The Head-HUNT Study Neurology, February 24, 2004; 62(4): 677 - 677. [Full Text] [PDF]

				R. B. Lipton and M. E. Bigal Chronic daily headache: Is analgesic overuse a cause or a consequence? Neurology, July 22, 2003; 61(2): 154 - 155. [Full Text] [PDF]

				G. Dyb, T. L. Holmen, and J.-A. Zwart Analgesic overuse among adolescents with headache: The Head-HUNT-Youth Study Neurology, January 24, 2006; 66(2): 198 - 201. [Abstract] [Full Text] [PDF]

Correspondence: