Objective:

To compare headache burden, psychological characteristics, and caffeine use between patients with medication-overuse headache (MOH) and non-MOH patients, and to assess the association between caffeine use disorder and severity of analgesic dependence in MOH.

Approach:

• Study Design: Cross-sectional study conducted on adults with primary headache disorders, utilizing validated questionnaires to assess caffeine consumption, headache impact, and psychological characteristics.
• Participants: 482 patients with primary headache disorders were recruited from four specialized headache clinics in Egypt.
• Data Collection: Participants completed questionnaires including caffeine food frequency (C-FFQ), caffeine use disorder (CUDQ), headache impact test-6 (HIT-6), Severity of Dependence Scale (SDS), and Depression Anxiety Stress Scales–12 (DASS-12).

Key Findings:

• 33.2% of participants met ICHD-3 criteria for MOH.
• MOH patients had significantly higher monthly headache days (MHD), acute medication days (AMD), and psychological distress scores compared to non-MOH patients (all p < 0.001).
• Heavy caffeine consumption was more prevalent in MOH patients (23.8% vs. 9.3%).
• Caffeine use disorder scores correlated positively with MHD, AMD, psychological distress scores, and SURPS scores (all p < 0.001).
• In MOH patients, dependence severity (SDS scores) correlated with MHD, AMD, caffeine use disorder scores, and SURPS scores (all p < 0.05).

Interpretation:

Limitations:

• The study was cross-sectional, limiting causal inferences.
• Participants were recruited from specialized clinics, which may not represent the general population of headache sufferers.

Conclusion:

Patients with MOH exhibit greater headache burden, psychological distress, and caffeine consumption compared to non-MOH patients.