No abstract

Medication overuse headache (MOH) is a common and disabling headache disorder. It has a prevalence of about 1-2 % in the general population. The International Classification of Headache Disorders 3rd edition (beta version) has defined MOH as a chronic headache disorder in which the headache occurs on 15 or more days per month due to regular overuse of medication. These headaches must have been present for more than 3 months. The pathophysiology is complex and not completely known. It involves genetic and behavioural factors. There is evidence that cortical spreading depression, trigeminovascular system and neurotransmitters contribute to the pain pathway of MOH. The treatment of MOH includes patient education, stopping the offending drug(s), rescue therapy for withdrawal symptoms and preventative therapy. Relapse rates for MOH are high at 41 %. MOH can severely impact quality of life, so it is important to identify patients who are at risk of analgesic overuse.

Cholesterol ester transfer protein (CETP) exchanges lipids between circulating plasma lipoproteins and has been considered as an excellent drug target for raising plasma levels of high-density lipoprotein (HDL) cholesterol. However, HDL displays considerably more complexity than low-density lipoprotein (LDL) in terms of structure, proteomics, and several physiologic functions. After the discouraging results from clinical trials of torcetrapib (an early inhibitor of CETP that dramatically raised HDL cholesterol levels), there is renewed hope that dalcetrapib and anacetrapib are sufficiently different structurally and functionally to justify large-scale clinical end point studies. In fact, such trials are already underway in the case of dalcetrapib and are imminent in the case of anacetrapib. These end point trials will show whether CETP inhibition will live up to its promise for atheroprotection.