• R B Grande, K Aaseth, J Saltyte Benth, P Gulbrandsen, M B Russell, and C Lundqvist.
• Head and Neck Research Group, Research Centre, Akershus University Hospital, Lørenskog 1478, Norway. r.berling.grande@medisin.uio.no
• J. Neurol. Neurosurg. Psychiatr. 2009 Jul 1;80(7):784-9.

ObjectiveTo evaluate the Severity of Dependence Scale (SDS) in people with primary chronic headache and analyse the pattern of medication overuse.DesignCross sectional epidemiological survey. A posted questionnaire screened for chronic headache. Neurological residents interviewed those with self-reported chronic headache. The International Classification of Headache Disorders was used. Split file methodology was employed for data analysis.SettingAkershus University Hospital, Oslo, Norway.ParticipantsA random sample of 30,000 people, aged 30-44 years, from the general population of Akershus County, Norway. 405 people had primary chronic headache.Main Outcome MeasureSDS score in those with and without medication overuse.ResultsThe screening questionnaire response rate was 71% and the participation rate of the interview 74%. Among 405 people with primary chronic headache, 95% had chronic tension-type headache, 4% had chronic migraine and <1% had other primary chronic headaches. Of 386 persons with chronic tension-type headache, 44% had medication overuse and 47% had co-occurrence of migraine. Simple analgesics, combination analgesics, triptans, ergotamine, opioids and a combination of acute medications were overused by 65%, 27%, 4%, <1%, 1% and 2% of people, respectively. The mean SDS score was significantly higher in those with than in those without medication overuse (5.6 vs 2.7; p<0.001).ConclusionThe SDS questionnaire detects medication overuse and dependency-like behaviour in persons with primary chronic headache.

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