Medication overuse headache: treatments often ineffective

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Takeaway

  • Medication overuse headaches (MOHs) do not seem to respond to many rescue and prophylactic treatments.

Why this matters

  • MOHs are extremely distressing to patients, so avoiding them is critical.
  • However, this meta-analysis shows that treatment, whether prophylactic or rescue, is often ineffective.
  • Clinicians may want to consider reducing acute treatments where possible.

Key results

  • 16 studies were considered in review, totaling 1105 patients.
  • Prednisone was not found to be significantly different from placebo or celecoxib in rescue trials.
  • No significant differences between inpatient and outpatient treatments.
  • No significant differences between valproate and topiramate in prophylaxis trials.
  • Prophylaxis trials showed a significant difference between amitriptyline and placebo.
  • Some benefit for 10 d less of acute medication, but the quality of evidence was low.

Study design

  • Systematic review and meta-analysis of RCTs, including crossover studies and cluster-randomized trials for MOHs in adults.
  • Funding: None disclosed.

Limitations

  • Researchers did not look for gray literature.
  • Most trials were small.