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. 2009 Oct 3;10(6):407–417. doi: 10.1007/s10194-009-0159-6

A narrative review on the management of medication overuse headache: the steep road from experience to evidence

Paolo Rossi 1,2,5,✉, Rigmor Jensen 3, Giuseppe Nappi 1,4, Marta Allena 1,4,✉; The COMOESTAS Consortium
PMCID: PMC3476213  PMID: 19802522

Abstract

The management of medication overuse headache (MOH) is based essentially on the withdrawal of the overused drug(s). Drug withdrawal is performed according to widely differing protocols, both within and across countries; therefore, therapeutic recommendations for the acute phase of detoxification vary considerably among studies. Basically, the aims of MOH management are: (a) to withdraw the overused drug(s); (b) to alleviate withdrawal symptoms by means of a bridge therapy, which includes pharmacological and non-pharmacological support, designed to help the patient to tolerate the withdrawal process; (c) to prevent relapse. Today, there is extensive debate over the best strategies for achieving these goals and the different aspects of this debate are discussed in this review. The authors searched for the best available evidence relating to the following questions: should medication withdrawal be abrupt or gradual? Should patients receive replacement therapy? What are the most effective therapeutic programmes for controlling withdrawal symptoms? Should replacement therapy be administered routinely or as rescue therapy? Should preventive treatment be started before, during or after withdrawal? What are the most effective preventive treatments? Should patients be managed through inpatient or outpatient withdrawal programmes? What is the best approach to adopt in preventing relapses? Treatment of MOH is a difficult challenge, but may be very rewarding. Although there is still a lack of high-quality studies providing evidence-based answers to the many specific questions it raises, neurologists need to know that the combination of education with a rational use of selected therapeutic strategies may be beneficial to people with chronic headache and help to relieve their suffering.

Keywords: Medication overuse headache, Therapy, Management, MOH, Review

Full Text

The Full Text of this article is available as a PDF (225.2 KB).

Acknowledgments

This manuscipt was prepared with funding from and within the activities of the COMOESTAS Project, VII FP, EC contract number 215366 (COMOESTAS) FP7—Thematic priority ICT (http://www.comoestas-project.eu).

Conflict of interest

None.

Appendix

C. Tassorelli (Project Manager), M. Allena, G. Sances, G. Sandrini, F. Blandini (IRCCS “Neurological Institute C. Mondino” Foundation, University Centre for Headache and Adaptive Disorders, Pavia), L. Bendtsen, S.B. Munksgaard (Danish Headache Centre, Glostrup Hospital), M. Lainez, B. Lopez (Fundación de la Comunidad Valenciana para la Investigación Biomédica, la Docencia y la Cooperación Internacional y para el Desarrollo del Hospital Clínico Universitario de Valencia, Spain), Z. Katsarava, D. Mueller (Department of Neurology, University Hospital of Essen), J. Leston, M.T. Goicoichea (Fundacion para la Lucha contra las Enfermedades Neurologicas de la Infanzia, Buenos Aires, Argentina), R. Fadic, B. Shand (Pontificia Universidad Catolica de Chile, Santiago, Chile).

Footnotes

The members of the Comoestas Consortium are given in the Appendix

An erratum to this article can be found at http://dx.doi.org/10.1007/s10194-009-0175-6

Contributor Information

Paolo Rossi, Phone: +39-06-94285259, FAX: +39-06-94285243, Email: paolo.rossi90@alice.it.

Marta Allena, Email: Marta.allena@mondino.it.

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