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Papers: 2 Feb 2019 - 8 Feb 2019


2019 May

Acta Neurol Scand



Treatment of Medication Overuse Headache – a review.


Munksgaard S B, Madsen S K, Wienecke T
Acta Neurol Scand. 2019 May; 139(5):405-414.
PMID: 30710346.


Medication overuse headache (MOH) is the most prevalent chronic headache disorder with a prevalence between 1-2% worldwide. The disease has been acknowledged for almost 30 years, yet experts still disagree on how best to treat MOH. By performing a search in PubMed on the terms "medication overuse headache", "analgesics abuse headache", "rebound headache", "drug induced headache", and "headache AND drug misuse" limited to human studies published in English between January 1 2004 and November 1 2017, we aimed to evaluate current literature concerning predictors of treatment outcome, inpatient and outpatient treatment programs, initial versus latent administration of prophylactic medications, and to review the effect of prophylactic medications. Selection criteria were prospective, comparative or controlled trials on treatment of MOH in persons of at least 18 years of age. Several studies evaluated risk factors to predict the outcome of MOH treatment, but many studies were underpowered. Psychiatric comorbidity, high dependence score and overuse of barbiturates, benzodiazepines and opioids predicted a poorer outcome of withdrawal therapy. Patients with these risk factors benefit from inpatient treatment, whereas patients without risk factors benefit equally from in and outpatient treatment. Some medications for migraine prophylactics have shown better effect on MOH compared with placebo, but not when combined with withdrawal. We conclude that detoxification programs are of great importance in MOH treatment. Latent administration of prophylactic medications reduces the number of patients needing prophylactic medication. Individualizing treatment according to the predictors of outcome may improve treatment outcome and thus reduce work-related and treatment-related costs. This article is protected by copyright. All rights reserved.