Characteristics of Patients with Chronic Episodic Bilious Headache

Study Objective: To study the characteristics and compliance of patients with bilious headache.

Study Design: Observational сomparative clinical trial.

Materials and Methods. We reviewed medical records of 184 patients treated for bilious headaches. The mean age was 42 ± 12 years old. Diagnosis of 82 (44.6%) patients combined bilious headache and drug-induced headaches (DIH). We examined the past history of bilious headaches, frequency of visits to the doctor, life-long use of medications to kill bilious headache, and preventive therapy. Also, we reviewed the factors impacting DIH development depending on prevalence of bilious headaches, comorbidities and medications used. 6 months after discharge from the hospital, participants took a survey on the efficiency of preventive management. We compared patients with and without DIH. Compliance of patients who started drug prevention was assessed using Morisky–Green questionnaire.

Study Results. 125 (67.9%) patients had chronic bilious headache, while in 59 (32.1%) patients, bilious headaches were episodic. Patients with chronic bilious headaches included 66 (52.8%) persons with DIH and 59 (47.2%) did not have any bilious headaches, while among patients with episodic bilious headache the figures were 16 (27.1%) and 43 (72.9%), respectively. In chronic bilious headache group, the frequency of DIH was statistically higher (p = 0.001). The correlation analysis of the relation between the duration of the history of bilious headaches and past drug therapy did not demonstrate any significant correlation between the amount of drugs used (grouped by the active ingredient) and course of disease (ρ = 0.115, p = 0.12); however, when drugs are counted on their trade names, there is a statistically significant correlation (ρ = 0.149, p = 0.048). Also, statistically significant correlation is seen when reviewing the duration of disease depending on the presence of DIH (p = 0.001): a longer past history of bilious headaches is associated with DIH development. 22 out of 184 patients (12%) did not start prescribed therapy. According to Morisky–Green questionnaire results, 137 (84.6%) patients were highly compliant, 21 (13%) were inadequately compliant, and 4 (2.5%) were not compliant at all. Most highly compliant were patients on antidepressants (p = 0.024). Patients with combined chronic bilious headache and DIH were also more compliant with preventive therapy (p = 0.045); patients without DIH mentioned beneficial effect from the therapy more often (p = 0.047).

Conclusion. A majority of patients were compliant with the therapy. We found out that 142 (78%) patients were familiar with preventive therapy; however, there was no statistically significant difference in compliance between such patients and naive subjects. Patients taking antidepressants and those without DIH are most compliant; they mentioned the beneficial effect of the preventive therapy more often, and this is a result not only of good compliance, but also of initially less severe disease.

1. Lipton R.B., Serrano D., Holland S., Fanning K.M. et al. Barriers to the diagnosis and treatment of migraine: effects of sex, income, and headache features. Headache. 2013; 53(1): 81–92. DOI: 10.1111/j.1526-4610.2012.02265.x

2. Peh K.Q.E., Kwan Y.H., Goh H., Ramchandani H. et al. An adaptable framework for factors contributing to medication adherence: results from a systematic review of 102 conceptual frameworks. J. Gen. Intern. Med. 2021; 36(9): 2784–95. DOI: 10.1007/s11606-021-06648-1

3. Kovalchuk N.A., Kiryanova E.A., Tabeeva G.R. Medication adherence in migraine patients (data of an online survey). Neurology, Neuropsychiatry, Psychosomatics. 2021; 13(4): 81–7. (in Russian). DOI: 10.14412/2074-2711-2021-4-81-87

4. Blumenfeld A.M., Bloudek L.M., Becker W.J., Buse D.C. et al. Patterns of use and reasons for discontinuation of prophylactic medications for episodic migraine and chronic migraine: results from the second international burden of migraine study (IBMS-II). Headache. 2013; 53(4): 644–55. DOI: 10.1111/head.12055

5. Dodick D., Loder E., Manack Adams A., Buse D.C. et al. Assessing barriers to chronic migraine consultation, diagnosis, and treatment: results from the chronic migraine epidemiology and outcomes (cameo) study. Headache. 2016; 56(5): 821–4. DOI: 10.1111/head.12774

6. Morisky D.E., Green L.W., Levine D.M. Concurrent and predictive validity of a self-reported measure of medication adherence. Med. Care. 1986; 24(1): 67–74. DOI: 10.1097/00005650-198601000-00007

7. Osipova V.V., Filatova E.G., Artemenko A.R., Lebedeva E.R. et al. Diagnosis and treatment of migraine: recommendations of the Russian experts. S.S. Korsakov Journal of Neurology and Psychiatry. 2017; 117(1–2): 28–42. (in Russian). DOI: 10.17116/jnevro20171171228-42

8. Chiang C.C., Schwedt T.J., Wang S.J., Dodick D.W. Treatment of medication-overuse headache: a systematic review. Cephalalgia. 2015; 36(4): 371–86. DOI: 10.1177/0333102415593088

9. Tassorelli C., Jensen R., Allena M., De Icco R. et al. A consensus protocol for the management of medication-overuse headache: evaluation in a multicentric, multinational study. Cephalalgia. 2014; 34(9): 645–55. DOI: 10.1177/0333102414521508

10. Golovacheva V.A., Parfenov V.A., Tabeeva G.R., Osipova V.V. et al. The optimization of management of chronic daily headache patients. S.S. Korsakov Journal of Neurology and Psychiatry. 2017; 117(2): 4–9. (in Russian). DOI: 10.17116/jnevro2017117214-9

11. Shagbazyan A.E., Kovalchuk N.A., Tabeeva G.R. Role of educational programs in management of patients with medicationoveruse headache. Neurology, Neuropsychiatry, Psychosomatics. 2021; 13(3): 27–33. (in Russian). DOI: 10.14412/2074-2711-2021-3-27-33