• C Lundqvist, J Š Benth, R B Grande, K Aaseth, and M B Russell.
• Head and neck research group, Research Centre, Akershus University Hospital, Lørenskog, Norway. a.c.lundqvist@medisin.uio.no
• Eur. J. Neurol. 2011 Mar 1; 18 (3): 512-8.

Background And ObjectiveMedication overuse headache is a common subtype of chronic headache involving the overuse of simple analgesics, opioids, ergotamine or triptans or combinations of these medications. Medication overuse may worsen the headache and has been described to have many characteristics similar to addiction. The purpose of this study was to validate and optimize the Severity of Dependence Scale (SDS) for use amongst people with chronic headache.Design/SettingIn a cross-sectional epidemiological survey, an age- and gender-stratified sample of 30,000 30- to 44-year-old people were recruited via a posted questionnaire. Those with self-reported chronic headache were interviewed by neurological residents at Akershus University Hospital, Oslo. Headache was classified according to the International Classification of Headache Disorders. Split file methodology was employed for data analysis.Main Outcome MeasureSeverity of Dependence Scale score in those with and without medication overuse.Results  Severity of Dependence Scale score was a significant predictor of medication overuse amongst chronic headache patients. Medication overuse could be predicted with sensitivity, specificity, positive and negative predictive values of 0.79, 0.84, 0.84 and 0.79, respectively, in men and 0.76, 0.77, 0.73 and 0.79 in women. Linear regression and factor analysis suggested a redundancy for the SDS question 'Do you think your use of your headache medication was out of control?' Removal of this question improved Chronbach's alpha=0.76.ConclusionThe SDS is valid for detecting medication overuse and dependency like behaviour amongst people with chronic headache. The adapted version may be used to identify chronic headache patients who may benefit from detoxification.© 2010 The Author(s). European Journal of Neurology © 2010 EFNS.

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