Disability in Chronic Migraine Patients With Medication Overuse: Treatment Effects at 1-Year Follow-up Licia Grazzi, MD; Frank Andrasik, PhD; Domenico D’Amico, MD; Susanna Usai, MD; Steven Kass, PhD; Gennaro Bussone, MD Objective.—To determine (1) the clinical course of a sample of chronic migraine patients with drug overuse 6 and 12 months following in-patient treatment and (2) whether functional impairment, assessed by the Migraine Disability Assessment (MIDAS) questionnaire, improved upon treatment. Background.—Patients with chronic migraine and medication overuse are particularly difficult to treat (prophy- lactic medications that otherwise are effective become ineffective; discontinuation of the offending medication can lead to withdrawal headache; physical and emotional dependence can be present, as well as increased psychological involvement; initial treatment gains can be difficult to maintain). Methods.—Of the 106 patients meeting criteria for chronic migraine with medication overuse, 84 went on to complete a structured in-patient treatment, consisting of medication withdrawal and then prophylactic treatment. Results.—As a group, the patients were improved at both 6- and 12-month follow-up, with respect to two headache parameters (frequency and medication use) and three measures of functional impact extracted from the MIDAS questionnaire (Total Score, Headache Frequency, and Headache Intensity). Conclusion.—Chronic migraine accompanied with medication overuse led to the considerable disability prior to treatment. However, notable improvement occurred coincident with the treatment. This suggests that successful treatment has more wide-ranging positive benefits beyond mere symptom reduction. To our knowledge, this is the first investigation where the MIDAS questionnaire has been used prospectively as an outcome measure in patients with chronic migraine and medication overuse to assess disability subsequent to a semi-standardized treatment program. Key words: chronic migraine, drug-induced headache, MIDAS, disability, long-term follow-up Abbreviation: MIDAS Migraine Disability Assessment (Headache 2004;44:678-683) Patients with chronic headaches and medication overuse are particularly difficult to treat for several reasons. First, prophylactic medications that otherwise are effective will rarely benefit these individuals. Sec- ond, discontinuation of the offending medication can lead to a withdrawal headache that is very severe in From the Neurological Institute “C.Besta,” Milan, Italy (Drs. Grazzi, D’Amico, Usai, and Bussone); Institute for Human and Machine Cognition, University of West Florida, Pensacola, FL (Dr. Andrasik); and Department of Psychology, University of West Florida, Pensacola, FL (Dr. Kass). Address all correspondence to Frank Andrasik, Institute for Human and Machine Cognition, University of West Florida, 40 South Alcaniz Street, Pensacola, FL 32502. Accepted for publication March 2, 2004. intensity, resembling an acute migraine attack. With- drawal headache is often accompanied by impor- tant vegetative symptoms that are worse short-term. Third, patients often show signs of physical and emo- tional dependence and some form of psychological in- volvement. Fourth, sustained improvement following treatment can be difficult to achieve and at the mo- ment there is no consensus on what approach is most effective. 1-3 Although several treatment studies have been published with chronic headache and medication overuse, 4,5 it is difficult to make comparative state- ments. One of the main reasons is different diag- nostic criteria have been used leading to heteroge- neous groups. In fact no clear consensus exists about 678