A Short Review on Medication-Overuse Headache

Background and objective: Medication-overuse headache (MOH) is a disabling and highly prevalent disease in neurologic clinics. Little evidence is available regarding treatment, but the suspension of overused medications, treatments using multidisciplinary approaches as well as absence of psychiatric comorbidities and overuse of drugs other than opioids are favorable outcome factors. Methods: We described key patient’s characteristics and treatment strategies carried out on consecutive patients with MOH from a specific tertiary center. The patients were submitted to a comprehensive approach with long-lasting initial consultations. The withdrawal of overused medications was conducted in all patients to whom different drugs for prevention were prescribed as well as the combination of a triptan plus an anti-inflammatory drug (NSAID) in a maximum intake of 2 days/week. Prednisone, as a bridge to detoxification, was given to 67.8% of the patients during the first 5-7 days. Results: After two months, 20.1% of the patients were lost to follow up and the mean headache frequency, among those who adhered, decreased to 10.7 headache days/month. After four and eight months, most of the patients were still under treatment with a mean headache frequency of 7.6 and 8.3 headache days/month. An intention to treat (ITT) analysis was also accomplished. After eight months, relapses or the use of symptomatic medications in 10 or higher days per month was observed in 23.8% of the patients (ITT 36.2%). Conclusion: The majority of patients with MOH undergoing comprehensive treatments show marked reduction in headache frequency, return to episodic presentation pattern and acceptable compliance with treatment directives despite previous therapeutic failures. Patient education, thorough evaluation and strict follow up even with patients previously seen as refractory, can lead to optimal clinical outcomes. Controlled studies on different treatment strategies are warranted.