Table 3.

Key points in the treatment of medication-overuse headache.

Setting	Most cases of MOH can be managed in primary care through patient education and advice to cut down on medication use for headache [Kristoffersen et al. 2015].
	Complex cases (characterized by long periods of overuse, intake of opioids or other psychoactive drugs, comorbid psychiatric or somatic disorders, or previous unsuccessful attempts at detoxification [Saper and Lake, 2006]) and those who failed detoxification in primary care should be referred for specialist care.
In-patient vs. outpatient	Both regimens are effective in the hospital setting, although the drop-out rate may be higher in the out-patient approach [Tassorelli et al. 2014].
Patient education	Patient education and constant support are needed to limit pain medication use and to prevent relapse [Munksgaard et al. 2011; Tassorelli et al. 2014]. Patients should be informed that even after MOH is resolved, their primary headache has not been cured. The difference is that there is a shift in the focus of management from acute treatment of pain to prevention of headache.
Treatment protocol	The best treatment involves discontinuation of the overused medication with the addition of preventive medication [Chiang et al. 2016]. There is disagreement on how to discontinue medication (gradual reduction versus complete withdrawal); and when to use preventive medication (early in the treatment period or after medication reduction).
	There is sparse data on best practice for the treatment of MOH in children [Gelfand and Goadsby, 2014].
Comorbidity	MOH has been linked to comorbid psychiatric disorders [Atasoy et al. 2012; Fuh and Wang, 2012; Radat and Lanteri-Minet, 2012]. Successful treatment of MOH appears to considerably reduce comorbid anxiety and depression [Bendtsen et al. 2014].
Team approach	Multidisciplinary treatment involving physicians, nurses, physiotherapists, and psychologists can make a difference [Munksgaard et al. 2012a; Pijpers et al. 2016] especially for the most treatment refractory patients [Munksgaard et al. 2012b].
Costs	Medication costs are substantially reduced after treatment [Shah et al. 2013].