Medication Overuse Headache
Hans-Christoph Diener, MD, PhD (University Essen) [November 20, 2018]
- Medication overuse headache constitutes between 25% and 50% of all patients with chronic migraine
- 2% of the global population suffers from chronic migraine (Natoli JL, Manack A, Dean B, Butler Q, Turkel CC, Stovner L, Lipton RB. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010 May;30(5):599-609).
- Medication overuse carries greater risks than just more headache: patients who overuse opioids are at risk of dependency and addiction.
Guideline of the EFNS headache panel. Evers S, Jensen R. Eur J Neurol. 2011 Sep;18(9):1115-21. doi: 10.1111/j.1468-1331.2011.03497.x.Department of Neurology, University of Münster, Münster, Germany Danish Headache Center, Department of Neurology, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark.
Background: Medication overuse headache is a common condition with a population-based prevalence of more than 1-2%. Treatment is based on education, withdrawal treatment (detoxification), and prophylactic treatment. It also includes management of withdrawal headache. Aims: This guideline aims to give treatment recommendations for this headache. Materials and methods: Evaluation of the scientific literature. Results: Abrupt withdrawal or tapering down of overused medication is recommended, the type of withdrawal therapy is probably not relevant for the outcome of the patient. However, inpatient withdrawal therapy is recommended for patients overusing opioids, benzodiazepine, or barbiturates. It is further recommended to start individualized prophylactic drug treatment at the first day of withdrawal therapy or even before. The only drug with moderate evidence for the prophylactic treatment in patients with chronic migraine and medication overuse is topiramate up to 200 mg. Corticosteroids (at least 60 mg prednisone or prednisolone) and amitriptyline (up to 50 mg) are possibly effective in the treatment of withdrawal symptoms. Patients after withdrawal therapy should be followed up regularly to prevent relapse of medication overuse. Protocol of COMOESTAS (Europe/Latin America): abrupt detoxification, patient eduction, initiation of prophylactic medication, followup by physician Alan Rapoport's protocol: start preventive several weeks prior, clonidine to prevent withdrawal, tricyclic for sleep and to help headache, frequent treatment from PhD behavioral specialist; bridge with steroids or dihydroergotamine
Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, Toom K, Vandervorst F, Quintana S, Paemeleire K, Katsarava Z. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain. 2018 Jul 13;19(1):50.link.springer.com/article/10.1186/s10194-018-0875-x doi: 10.1186/s10194-018-0875-x. Review. PubMed PMID: 30003412.vandenbussche-medication-overuse-headache-jheadachepain2018.pdf
Background: Medication overuse headache is a common condition with a population-based prevalence of more than 1-2%. Treatment is based on education, withdrawal treatment (detoxification), and prophylactic treatment. It also includes management of withdrawal headache. Aims: This guideline aims to give treatment recommendations for this headache. Materials and methods: Evaluation of the scientific literature. Results: Abrupt withdrawal or tapering down of overused medication is recommended, the type of withdrawal therapy is probably not relevant for the outcome of the patient. However, inpatient withdrawal therapy is recommended for patients overusing opioids, benzodiazepine, or barbiturates. It is further recommended to start individualized prophylactic drug treatment at the first day of withdrawal therapy or even before. The only drug with moderate evidence for the prophylactic treatment in patients with chronic migraine and medication overuse is topiramate up to 200 mg. Corticosteroids (at least 60 mg prednisone or prednisolone) and amitriptyline (up to 50 mg) are possibly effective in the treatment of withdrawal symptoms. Patients after withdrawal therapy should be followed up regularly to prevent relapse of medication overuse. Protocol of COMOESTAS (Europe/Latin America): abrupt detoxification, patient eduction, initiation of prophylactic medication, followup by physician Alan Rapoport's protocol: start preventive several weeks prior, clonidine to prevent withdrawal, tricyclic for sleep and to help headache, frequent treatment from PhD behavioral specialist; bridge with steroids or dihydroergotamine
Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, Toom K, Vandervorst F, Quintana S, Paemeleire K, Katsarava Z. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain. 2018 Jul 13;19(1):50.link.springer.com/article/10.1186/s10194-018-0875-x doi: 10.1186/s10194-018-0875-x. Review. PubMed PMID: 30003412.vandenbussche-medication-overuse-headache-jheadachepain2018.pdf