Yacoub, Osama

Background Caffeine plays a dual role in headache disorders, acting as an analgesic adjuvant while potentially contributing to headache chronification. Its relationship with medication-overuse headache (MOH) and the severity of analgesic dependence remains insufficiently characterized. The study aimed to compare MOH and non-MOH patients in terms of headache burden, psychological characteristics, and caffeine use, and secondarily to assess whether caffeine use disorder is associated with severity of dependence on analgesics in MOH. Methods This is a cross-sectional study conducted on adults with primary headache disorders. Participants were asked to complete the following validated questionnaires: caffeine food frequency (C-FFQ), caffeine use disorder (CUDQ), headache impact test-6 (HIT-6), Severity of Dependence Scale (SDS). Depression Anxiety Stress Scales–12 (DASS-12), and Substance Use Risk Profile Scale (SURPS). Headache diaries were reviewed to document monthly headache days (MHD) and acute medication days (AMD); subsequently, patients were divided into MOH or non-MOH groups, according to ICHD-3 criteria. Results Among 482 patients with primary headache disorders, 160 (33.2%) fulfilled ICHD-3 criteria for MOH. Patients with MOH had significantly higher MHD, AMD, HIT-6 scores, DASS-12 and SURPS total scores than those with non-MOH (all p < 0.001). Heavy caffeine consumption was more prevalent in MOH patients (23.8% vs. 9.3%), who also demonstrated higher CUDQ scores (median 10 vs. 7, p < 0.001). CUDQ scores correlated positively with MHD, AMD, HIT-6, DASS-12, and SURPS (all p < 0.001). Among patients with MOH, SDS scores correlated with MHD, AMD, HIT-6, DASS-12, SURPS, and CUDQ scores (all p < 0.05). Multivariable regression analysis revealed that AMD, HIT-6 score, and CUDQ score were independently associated with SDS scores ( p -value = 0.002, 0.046, 0.002, respectively). Conclusion Patients with MOH had significantly greater headache burden, psychological distress, and caffeine consumption compared with those without MOH. Caffeine use disorder is significantly associated with greater severity of analgesic dependence in patients with MOH. These findings highlight the importance of assessing caffeine-related behaviors when evaluating patients with MOH and suggest that caffeine use disorder may represent a clinically relevant behavioral factor associated with medication dependence severity.

Background Despite consistent epidemiological evidence identifying smoking as a risk factor for medication-overuse headache (MOH), the mechanisms underlying this association remain incompletely elucidated. The aim of this work was to explore the relationship between the severity of analgesic dependence, headache-related disability, nicotine dependence, psychological distress, and addiction-related personality traits in patients with MOH. Methods This multicenter cross-sectional study was conducted on 442 patients with primary headache disorders. Participants underwent structured face-to-face interviews and were asked to fill out the following questionnaires: Headache Impact Test–6 (HIT-6), Severity of Dependence Scale (SDS), Depression Anxiety Stress Scales-12 (DASS-12), and Substance Use Risk Profile Scale (SURPS). Smoking status was documented for all participants. Current smokers were asked to complete Fagerström Test for Nicotine Dependence questionnaire (FTND). Results This study included 442 patients with primary headache disorders, of whom 150 had MOH and 292 did not. Patients with MOH (n = 150) reported significantly higher monthly headache days (MHD), acute medication days (AMD), HIT-6, DASS-12, and SURPS scores than those without MOH (n = 292) (all P-values < 0.001). Smoking prevalence and FTND scores were significantly higher among MOH patients than those without MOH (all P-values < 0.001). Smokers demonstrated higher MHD, AMD, prevalence of MOH, DASS-12, and SURPS scores than non-smokers (all P-values < 0.05). Among smokers, FTND correlated positively with MHD, AMD, HIT-6, DASS-12, and SURPS (all P-values < 0.001). In patients with MOH, SDS scores showed positive correlations with AMD, HIT-6, DASS-12, and SURPS (all P-values < 0.05). Conclusion Severity of dependence on analgesics in patients with MOH is strongly associated with headache burden, nicotine dependence, psychological distress, and addiction-related personality traits.

Background There is growing evidence suggesting a bidirectional relationship between fibromyalgia and migraine. The aim of this work was to study the impact of fibromyalgia on the frequency and severity of migraine headache attacks and the psychological burden in patients with comorbid migraine and fibromyalgia. Methods This cross-sectional comparative study was conducted on 114 patients with comorbid migraine and fibromyalgia and 270 patients with migraine only. All included patients were subjected to a comprehensive assessment of headache through face-to-face interview and assessment of the psychological state using the Depression, Anxiety and Stress Scale-12 (DASS-12). Patients with fibromyalgia were requested to answer the Revised Fibromyalgia Impact Questionnaire (FIQR). Results Patients with comorbid migraine and fibromyalgia had significantly higher monthly migraine days (MMD), headache impact test-6 (HIT-6), and DASS-12 total scores than patients with migraine only ( p -value &lt; 0.001, 0.009, and &lt; 0.001, respectively). There was a statistically significant positive correlation between the FIQR total score and DASS-12 total score ( p -values = 0.001). Additionally, statistically significant positive correlations were found between the FIQR total score and both the MMD and HIT-6 total scores ( p -values = 0.002 and 0.008, respectively). There were also statistically significant positive correlations between the DASS-12 total score and both the MMD and HIT-6 total scores ( p -values = 0.006, 0.027, respectively). Conclusion Fibromyalgia is an aggravating comorbid condition with migraine that is associated with a higher frequency and severity of migraine headache attacks, in addition to increasing the psychological burden.