Clinical Science: Treatment of Medication Overuse Headache and Long-term Outcome

Medication overuse headache is an important and challenging problem for clinicians and researchers. The new International Headache Society classification now gives specific limits for medication use based on the number of days of treatment per month. Medication overuse headache is increasingly recognized in children. Triptan overusers have a more migrainous phenotype than overusers of other medications, as well as a shorter period of induction and a milder and more ultimately successful medication withdrawal course. Treatment may involve weaning the overused medications or abrupt discontinuation using a transitional medication for 1 or 2 weeks. Detoxification may be performed in an inpatient or outpatient setting. Repetitive intravenous valproate, prochlorperazine, or lidocaine may be reasonable alternatives to the traditional treatment of metoclopramide and dihydroergotamine. Biofeedback-assisted relaxation training improves outcomes after detoxification at 3 years. Even aggressive treatment is unsuccessful in a significant number of cases.