Pathophysiology, prevention, and treatment of medication overuse headache

Diener, Hans‐Christoph; Dodick, David W.; Evers, Stefan; Holle, Dagny; Jensen, Rigmor; Lipton, Richard B.; Porreca, Frank; Silberstein, Stephen D.; Schwedt, Todd J.

doi:10.1016/s1474-4422(19)30146-2

Cited by 174 publications

(214 citation statements)

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“…In this era of new preventive treatments for headache, the question whether withdrawal from medication overuse is necessary resurfaces, as sub‐analyses of multiple preventive trials have found significant reductions of medication overuse in the absence of withdrawal. Dedicated, well‐powered clinical trials in MOH patients may offer new answers and are awaited 24 . The International Headache Society (HIS) guidelines contain subsections on comorbid MOH, with chronic migraine to guide trial developers in assessing the effects of drugs or interventions on MOH 189 …”

Section: Discussion and Future Directionsmentioning

confidence: 99%

“…The pathophysiology of MOH is incompletely understood. The development of MOH is associated with a background of a primary headache disorder, frequent intake of analgesics, increasing frequency of headaches, psychological and personality traits, and genetic predisposition 24,25 . Genes involved in pain, drug‐dependence, metabolic, serotonergic, and dopaminergic pathways have been linked to MOH 24‐28 .…”

Section: Introductionmentioning

confidence: 99%

“…The development of MOH is associated with a background of a primary headache disorder, frequent intake of analgesics, increasing frequency of headaches, psychological and personality traits, and genetic predisposition 24,25 . Genes involved in pain, drug‐dependence, metabolic, serotonergic, and dopaminergic pathways have been linked to MOH 24‐28 . Interestingly, regular use of analgesics for a non‐headache indication is associated with the development of chronic headache, specifically in migraine patients 29,30 .…”

Section: Introductionmentioning

confidence: 99%

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The Many Faces of Medication‐Overuse Headache in Clinical Practice

2020

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The management of medication-overuse headache (MOH) is multifaceted and headache experts have different views on the optimal strategy to tackle this type of secondary headache. The purpose of this review is to provide an overview of the literature on the management of MOH, and to highlight important considerations in the clinical evaluation of the MOH patient.Managing MOH in clinical practice starts by evaluating the headache patient with medication overuse, determining the overused drug(s), assessing the impact of headaches on the patient and assessing comorbid conditions and disorders. Withdrawal of the overused medication is the cornerstone of treatment. An inpatient or outpatient setting is chosen based on the clinical profile of the patient. There is evidence for abrupt withdrawal combined with headache preventive treatment.Bridging therapy to bring relief to withdrawal headaches and/or symptoms should be offered. Education and motivational work through multidisciplinary assessment show benefits in sustaining withdrawal and preventing relapse.Although the reversal of chronic headache after cessation of overused acute medication has been noticed worldwide, different aspects of the management of MOH, such as complete or gradual withdrawal, or preventive treatment with or without withdrawal are still debated.

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Section: Discussion and Future Directionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Many Faces of Medication‐Overuse Headache in Clinical Practice

2020

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“…The reliance on acute treatments exclusively, especially in those with frequent attacks, may lead to overuse of acute medications and the development of medication overuse headache and chronic migraine. 10 A recent study evaluated cycling of preventive migraine medications from a claims database and found that for patients with episodic and chronic migraine, more than 75% of patients switched or discontinued their initial preventive treatment within 12 months, leading to increased healthcare resource utilization and cost. 11 Galcanezumab is a humanized monoclonal antibody that potently and selectively binds to the CGRP ligand 12,13 and is approved for the preventive treatment of migraine in adults.…”

Section: Introductionmentioning

confidence: 99%

Rapid Onset of Effect of Galcanezumab for the Prevention of Episodic Migraine: Analysis of the EVOLVE Studies

et al. 2019

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Objective.-To evaluate onset of effect of galcanezumab in patients with episodic migraine. Background.-Galcanezumab is a monoclonal antibody that binds to calcitonin gene-related peptide and is indicated for preventive treatment of migraine. Design/Methods.-Data on the primary outcome measure were analyzed from 2 previously published double-blind, Phase 3 studies (EVOLVE-1 [N = 858] and EVOLVE-2 [N = 915]) wherein adult patients with episodic migraine were randomized to receive monthly subcutaneous injections of galcanezumab 120 mg (with 240-mg loading dose) or 240 mg or placebo for up to 6 months. Monthly onset of effect was defined as the earliest month at which galcanezumab achieved and subsequently maintained statistical superiority to placebo on the mean change from baseline in the number of monthly migraine headache days (MHDs). If onset occurred in Month 1, weekly onset was evaluated and defined as the earliest week at which galcanezumab statistically separated from placebo and maintained statistical separation for remaining weeks in that month. Day of onset of effect was also analyzed, as were monthly and weekly onset, for occurrence of ≥50% reduction from baseline in number of MHDs. Results.-For both studies, change from baseline in monthly MHDs showed a statistically significant separation of galcanezumab from placebo at Month 1 and each subsequent month (each P < .001). Analysis of the first month for both studies indicated onset of effect in the first week, with galcanezumab-treated patients having significantly higher odds of having fewer MHDs in the first week (odds ratio [95% confidence interval] for EVOLVE-1, 2.71 [2.00, 3.66], and for EVOLVE-2, 2.88 [2.16, 3.86]; both P < .001) and each subsequent week compared with placebo-treated patients (P ≤ .004). Daily analysis showed onset of effect at Day 1 (first day after injection day). Galcanezumab also demonstrated superiority to placebo on occurrence of ≥50% reduction in MHDs starting at Week 1 (percentage of patients with 50% response in galcanezumab group vs placebo group for EVOLVE-1, 54.3% vs 32.4% [P < .001], and for EVOLVE-2, 59.4% vs 38.0% [P < .001]). Conclusion.-Rapid onset of preventive effect on the first day after injection of galcanezumab was confirmed in both studies of episodic migraine.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

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“…Dies wurde von den Firmen, die Triptane herstellten und vertrieben in ihrem Marketing unterstellt. Zum einen haben Tripta-ne keine prophylaktische Wirkung und zum anderen kann der zu häufige Gebrauch von Triptanen zu einem medikamenteninduzierten Dauerkopfschmerz führen [13,14].…”

Section: Introductionunclassified

Tops und Flops der Kopfschmerztherapie

Diener¹,

Limmroth²,

Gaul³

2019

Nervenheilkunde

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ZUSAMMENFASSUNGDie Therapie akuter Migräneattacken und die Prophylaxe der Migräne wurde durch Fortschritte in den Erkenntnissen der Pathophysiologie der Migräne und die Entwicklung neuer Substanzklassen in den letzten 30 Jahren dramatisch verbessert. Dazu gehört die Einführung der Triptane. Antagonisten gegen Substanz-P waren allerdings nicht wirksam. In der Migräneprophylaxe waren neben den etablierten Medikamenten auch Topiramat und bei der chronischen Migräne Onabotulinumtoxin A wirksam. Neue Ansätze ergeben sich durch die neuen monoklonalen Antikörper gegen CGRP oder den CGRP-Rezeptor. Wichtige Fortschritte gab es in der Epidemiologie und Therapie des chronischen Kopfschmerzes durch Übergebrauch von Schmerz- oder Migränemittel. Patienten mit diesem Krankheitsbild sollten bevorzugt in Schwerpunktpraxen oder Kopfschmerzzentren behandelt werden.

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Pathophysiology, prevention, and treatment of medication overuse headache

Cited by 174 publications

References 90 publications

The Many Faces of Medication‐Overuse Headache in Clinical Practice

The Many Faces of Medication‐Overuse Headache in Clinical Practice

Rapid Onset of Effect of Galcanezumab for the Prevention of Episodic Migraine: Analysis of the EVOLVE Studies

Tops und Flops der Kopfschmerztherapie

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