Combined Pharmacological and Short-Term Psychodynamic Psychotherapy for Probable Medication Overuse Headache: A Pilot Study

Altieri, Marta; Giambattista, Romina Di; Clemente, Laura Di; Fagiolo, Denise; Tarolla, Emanuele; Mercurio, Arthur M.; Vicenzini, Edoardo; Tarsitani, Lorenzo; Lenzi, G; Biondi, Massimo; Piero, Vittorio Di

doi:10.1111/j.1468-2982.2008.01717.x

Cited by 43 publications

(34 citation statements)

References 32 publications

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“…In a quasi-randomised controlled trial ( n = 61) the addition of biofeedback-assisted relaxation therapy to preventive medication did not increase the success rate at 3 years and, though the patients in the combined group were less likely to relapse, this finding did not reach statistical significance when subjected to an intention-to-treat analysis [46]. Recently, in a very limited number of MOH patients ( n = 27) having migraine as primary headache, it was shown at the 12-month follow-up that the decrease in headache frequency and medication intake was greater, and the relapse rate lower, in patients receiving psychoanalysis-based psychotherapy in addition to prophylactic treatment than in those receiving only pharmacotherapy [47]. Of course, these findings need to be confirmed in further randomised controlled studies enrolling a larger number of patients.…”

Section: What Is the Best Approach To Adopt In Preventing Relapses?mentioning

confidence: 99%

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

et al. 2009

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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.

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Section: What Is the Best Approach To Adopt In Preventing Relapses?mentioning

confidence: 99%

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

et al. 2009

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“…Out of 443 abstracts reviewed, a total of 29 studies were eligible [10–39]. Additional file 1: Figure S1 shows the flow chart, and Additional file 1: Table S1 show the list of studies excluded following full-text review with accompanying reason for exclusion.…”

Section: Methodsmentioning

confidence: 99%

Risk of medication overuse headache across classes of treatments for acute migraine

et al. 2016

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BackgroundThe most commonly prescribed medications used to treat migraine acutely are single analgesics, ergots, opioids, and triptans. Due to varying mechanisms of action across drug classes, there is reason to believe that some classes may be less likely than others to elicit Medication Overuse Headache (MOH) than others. We therefore aimed to determine whether certain classes of acute migraine drugs are more likely to elicit MOH than others.MethodsA comprehensive systematic literature was conducted to identify studies of varying designs that reported on MOH within the considered treatment classes. Only studies that reported MOH according to the International Classification of Headache Disorders (ICHD) were considered. Since no causal comparative design studies were identified; data from prevalence studies and surveys were retrieved. Prevalence-based relative risks between treatment classes were calculated by integrating both medication overuse and medication use from published studies. For each pair wise comparison, pooled relative risks were calculated as the inverse variance weighted average.ResultsA total of 29 studies informed the relative risk between treatment classes, all of which reported country-specific data. Five studies reported country-specific medication use data. For triptans versus analgesics the study relative risks generally favored triptans. The pooled relative risk was 0.65 (i.e., relative risk reduction of 35 %). For ergots versus analgesics, a similar trend was observed in favor of ergots with a relative risk of 0.41. For triptans versus ergots, the direction of effect was mixed, and the pooled relative risk was 1.07. Both triptans and ergots appeared favorable when compared to opioids, with pooled relative risks of 0.35 and 0.76, respectively. However, the evidence was limited for these comparisons. Analgesics and opioids also appeared to yield similar risk of MOH (pooled relative risk 1.09).ConclusionOur study suggests that in patients receiving acute migraine treatment, analgesics and opioids are associated with a higher risk of developing MOH compared with other treatments. These findings provide incentive for better monitoring of use of analgesics and opioids for treating acute migraine, and suggest possible clinical preference for use of so-called “migraine-specific” treatments, that is, triptans and ergots.Electronic supplementary materialThe online version of this article (doi:10.1186/s10194-016-0696-8) contains supplementary material, which is available to authorized users.

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“…They include cognitive-behavioural therapy (as effective as amitriptyline but slower) [415], short-term psychodynamic psychotherapy (determining a lower rate of relapse in analgesic overuse than placebo after weaning) [416], osteopathic, chiropractic and massage protocols (contraindicated in the case of fractures, bone lesions and osteoporosis) [417, 418], Physiotherapy/Physical Exercise (several techniques showed to be effective but the results are not comparable because non homogeneous methods have been used in different studies) [419, 420] and orthodontic/gnathological techniques (an intraoral removable device induced an improvement similar to amitriptyline’s one) [421]. All the aforementioned non pharmacologic techniques have been rated at the level of recommendation III.…”

Section: Non-pharmacological Therapy Of Primary Headachesmentioning

confidence: 99%

Italian guidelines for primary headaches: 2012 revised version

et al. 2012

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The first edition of the Italian diagnostic and therapeutic guidelines for primary headaches in adults was published in J Headache Pain 2(Suppl. 1):105–190 (2001). Ten years later, the guideline committee of the Italian Society for the Study of Headaches (SISC) decided it was time to update therapeutic guidelines. A literature search was carried out on Medline database, and all articles on primary headache treatments in English, German, French and Italian published from February 2001 to December 2011 were taken into account. Only randomized controlled trials (RCT) and meta-analyses were analysed for each drug. If RCT were lacking, open studies and case series were also examined. According to the previous edition, four levels of recommendation were defined on the basis of levels of evidence, scientific strength of evidence and clinical effectiveness. Recommendations for symptomatic and prophylactic treatment of migraine and cluster headache were therefore revised with respect to previous 2001 guidelines and a section was dedicated to non-pharmacological treatment. This article reports a summary of the revised version published in extenso in an Italian version.

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Combined Pharmacological and Short-Term Psychodynamic Psychotherapy for Probable Medication Overuse Headache: A Pilot Study

Cited by 43 publications

References 32 publications

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

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

Risk of medication overuse headache across classes of treatments for acute migraine

Italian guidelines for primary headaches: 2012 revised version

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