The Effectiveness of Treatments for Patients With Medication Overuse Headache: A Systematic Review and Meta-Analysis

Goffau, Maaike J. de; Klaver, Andre R.E.; Willemsen, Marjolein G.; Bindels, Patrick J E; Verhagen, Arianne P.

doi:10.1016/j.jpain.2016.12.005

Cited by 57 publications

(57 citation statements)

References 32 publications

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“…Another randomized, single‐blinded trial failed to show superiority of IV methylprednisolone, nor IV acetaminophen versus IV placebo in reducing withdrawal headache intensity 13 . Meta‐analysis did not find evidence that prednisone significantly reduced headache days during the withdrawal stage versus placebo 14 …”

Section: Managing the Headache Patient With Medication Overusementioning

confidence: 99%

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: Managing the Headache Patient With Medication Overusementioning

confidence: 99%

The Many Faces of Medication‐Overuse Headache in Clinical Practice

2020

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“…48,52 In the latter study of OBTA, the therapeutic gain was only 2 d/mo. 56 A recent population-based study by Hepp et al 57 showed that the adherence to oral migraine prophylactics in patients with chronic migraine is only 25% after 6 months and more than 50% discontinue the new prophylactic drug during the first two months due to adverse events and lack of effect on headache. 56 A recent population-based study by Hepp et al 57 showed that the adherence to oral migraine prophylactics in patients with chronic migraine is only 25% after 6 months and more than 50% discontinue the new prophylactic drug during the first two months due to adverse events and lack of effect on headache.…”

Section: Discussionmentioning

confidence: 99%

“…52 Even though this difference was statistically significant, this effect cannot be con- AEDs or OBTA as prophylactic treatment to MOH patients. 56 A recent population-based study by Hepp et al 57 showed that the adherence to oral migraine prophylactics in patients with chronic migraine is only 25% after 6 months and more than 50% discontinue the new prophylactic drug during the first two months due to adverse events and lack of effect on headache. On this basis, it is very relevant to consider awaiting initiation of prophylactic medication until after the effect of detoxification alone is known.…”

Section: Discussionmentioning

confidence: 99%

Treatment of medication overuse headache—A review

2019

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Medication overuse headache (MOH) is the most prevalent chronic headache disorder with a prevalence between 1% and 2% worldwide. The disease has been acknowledged for almost 30 years, yet experts still disagree on how best to treat MOH.By performing a search in PubMed on the terms "medication overuse headache," "analgesics abuse headache," "rebound headache," "drug induced headache," and "headache AND drug misuse" limited to human studies published in English between January 1, 2004, and November 1, 2017, we aimed to evaluate current literature concerning predictors of treatment outcome, inpatient and outpatient treatment programs, initial versus latent administration of prophylactic medications, and to review the effect of prophylactic medications. Selection criteria were prospective, comparative, or controlled trials on treatment of MOH in persons of at least 18 years of age. Several studies evaluated risk factors to predict the outcome of MOH treatment, but many studies were underpowered. Psychiatric comorbidity, high dependence score, and overuse of barbiturates, benzodiazepines, and opioids predicted a poorer outcome of withdrawal therapy. Patients with these risk factors benefit from inpatient treatment, whereas patients without risk factors benefit equally from inpatient and outpatient treatment. Some medications for migraine prophylactics have shown better effect on MOH compared with placebo, but not when combined with withdrawal. We conclude that detoxification programs are of great importance in MOH treatment. Latent administration of prophylactic medications reduces the number of patients needing prophylactic medication. Individualizing treatment according to the predictors of outcome may improve treatment outcome and thus reduce work-related and treatment-related costs. K E Y W O R D Sadverse effects, detoxification programs, medication overuse headache, neuropharmacology, prophylactic headache medication, treatment

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“…Even in the highest impact journals, many trialists continue to inadequately report or calculate sample sizes . In the headache literature, one needs to look no further than recent systematic reviews to understand the commonality of underpowered studies …”

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confidence: 99%

“…1 In the headache literature, one needs to look no further than recent systematic reviews to understand the commonality of underpowered studies. [2][3][4][5][6] In this issue, Turner and Houle clearly and eloquently summarize the role that statistical power calculations play in research design, the key elements required to calculate statistical power, common problems with power calculations and, finally, they propose advice for researchers planning studies. As outlined in their manuscript, the foundation of scientific research is hypothesis testing.…”

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confidence: 99%