Going cold turkey is best for medication-overuse headache

  • Nielsen M & al.
  • Cephalalgia
  • 7 Feb 2019

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • Patients with medication-overuse headache (MOH) who stopped acute analgesics or migraine medications altogether had a bigger decrease in MOH-related disability and reported an improved QoL much sooner than those who just restricted their medication use to twice a week.

Why this matters

  • The recommended treatment for MOH is to stop the overuse of medication, but there is no consensus on the best approach for withdrawal.

Study design

  • This prospective outpatient study randomly allocated 72 MOU patients with primary migraine and/or tension-type headache to 2 months either without acute analgesics/migraine medications (program A) or with acute medications restricted to 2 days/week (program B).
  • Disability and headache burden assessed by Headache Under-Response to Treatment index (HURT), and QoL by EUROHIS-QOL.
  • Funding: Danish Medical Society Copenhagen; TrygFoundation.

Key results

  • At 12 months' follow-up, reduction in disability (25% vs 7%; P=.027) and headache burden (33% vs 3%; P=.005) was significantly higher in program A vs program B.
    • QoL increased by 8% in both programs (P=.30).
  • At 2-month follow-up, QoL increased significantly more in program A vs program B (P=.006).

Limitations

  • Most complicated patients needing in-patient treatment not included.
  • A number of patients did not complete all questionnaires.

Coauthored with Antara Ghosh, PhD