VALENCIA, SPAIN – Medication overuse headache is strongly associated with sky-high stress levels and several unhealthy – yet modifiable – lifestyle behaviors, according to a large Danish population-based study.
“High stress plus smoking, low physical activity, or obesity has synergistic effects in medication overuse headache. So stress reduction is highly relevant in medication overuse headache [MOH] management,” Dr. Rigmor H. Jensen reported at the International Headache Congress.
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Stopping the offending medications remains central to the successful treatment of MOH. And while bearing in mind that association doesn’t prove causality, the findings of the Danish study suggest that stress reduction and lifestyle modification, in addition to their many recognized mental and physical health benefits, might also have some MOH-specific effects, according to Dr. Jensen, professor of neurology and director of the Danish Headache Center at the University of Copenhagen.
She presented the results of a questionnaire survey sent to a representative sample comprising 129,150 Danish adults. The survey focused on headache symptoms, lifestyle, and stress as measured by the validated 10-question perceived stress scale. The survey response rate was 53%, a figure so high as to likely elicit envy among U.S. researchers.
A total of 3.4% of the 68,518 respondents were classified as having chronic headache based upon self-report of headache on at least 15 days per month for 3 months. This group was then further categorized as having MOH by the standard International Classification of Headache Disorders definition – as did 1.8% of the total study population – or chronic headache without medication overuse.
Of adults with MOH, 58% scored in the top fifth of the total study population in terms of stress level. Those with chronic headache without medication overuse were less well represented at the high end of the stress spectrum: 46% of them were in the top stress quintile, as were 18% of people without chronic headache, she reported at the meeting sponsored by the International Headache Society and the American Headache Society.
Dr. Jensen and coinvestigators examined the relationship between MOH, stress level, and five unhealthy lifestyle behaviors: daily smoking, excessive alcohol intake, physical inactivity, obesity, and illicit drug use. In multivariate logistic regression analysis, smoking, physical inactivity, and obesity were strongly associated with MOH, while excessive drinking and illicit drug use were not.
Women in the top quintile for stress were 3.8-fold more likely to have MOH if they were a smoker than if they smoked but were in any of the four lower-stress quintiles, 3.5-fold more likely to have MOH if sedentary and high rather than lower stress, and 2.9-fold more likely if obese. For men in the top quintile for stress, the respective odds ratios for MOH were all in the 5-5.6 range for the three lifestyles.
After controlling for stress level, the odds of having MOH were greatest among individuals with all three unhealthy behaviors, compared with those with none: a 5.1-fold increase among men and 2.8-fold increase in women.
In terms of a theoretic goal for stress reduction that might be a useful target as part of the long-term management of MOH, it appears from the Danish data that patients wouldn’t need to attain super-relaxed, below-average stress levels. The independent association between stress and MOH was statistically significant only for individuals in the top two stress quintiles. Men in the fifth or top quintile for stress were 10.3-fold more likely to have MOH than those in the first quintile, while those in the fourth quintile were 4.3-fold more likely to have MOH than those in the first. In women the associations were less dramatic: a 3.9-fold increased risk of MOH if they were in the fifth stress quintile and a 2-fold increase in the fourth.
This study was funded by Danish governmental research agencies. Dr. Jensen reported having no financial conflicts.