Scheduled Outpatient Intravenous Infusion per Headache Protocol and Effect on Migraine-related Quality of Life in Patients with Chronic Daily Headaches

Abstract

Chronic Daily Headache (CDH) and Medication overuse headaches (MOH) are important public health problems. CDH is defined as a headache occurring on 15 days or more per month over three month duration with a worldwide prevalence of 4%. MOH is a daily or near daily headache over 15 days a month that results from overuse of migraine abortive medications and is one of the most common chronic headache disorders (worldwide prevalence of 1-2%). A total of 56 patients were enrolled in the study. 51 patients completed a one month follow-up and 39 patients completed a two month follow-up. After informed consent, migraine specific quality of life questionnaire (MSQ 2.1) and patient rating of migraine specific measures were administered on the first day of treatment and at 5 and 10 weeks following completion of treatment. The protocol included IV DHE, IV magnesium, IV Decadron, IV Depacon based on standard factors identified by the headache specialist and as needed Toradol, Benadryl and anti-nausea medications headache frequency and severity was decreased. Migraine associated photophobia and phonophobia improved markedly (p<0.0001) and number of people needing abortive medication more than 10 days a month was reduced by 40%. The data provide evidence for the efficacy of scheduled outpatient intravenous therapy per the headache center protocol for CDH and suggests that patients experience diminished frequency and intensity of headaches with improved quality of life one month and two months post therapy. Outpatient settings and timings provided a more comfortable and time effective setting to patients and families with decrease visits to the emergency room with a will prove to be a more cost effective method of treatment.