Medication Overuse Headache: Withdrawal and Prophylactic Therapeutic Regimen

• Published in: Headache Vol. 50; no. 6; pp. 989 - 997
• Main Authors: Trucco, Marco, Meineri, Piero, Ruiz, Luigi, Gionco, Maurizio
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01-06-2010; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Aged; Analgesics - adverse effects; Biological and medical sciences; Clinical Protocols; Daily Drug Intake; detoxification; drug withdrawal; Female; Headache Disorders, Secondary - chemically induced; Headache Disorders, Secondary - therapy; Headache Index; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Intention to Treat Analysis; Male; Medical sciences; medication overuse headache; Middle Aged; Nervous system (semeiology, syndromes); Neurology; prophylactic therapy; Severity of Illness Index; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system; Headache; Nervous system diseases; Daily Drug Intake; Cerebral disorder; medication overuse headache; prophylactic therapy; Chemotherapy; Treatment; Pain; Headache Index; Central nervous system disease; Neurological disorder; detoxification; drug withdrawal; Cerebrovascular disease
• ISSN: 0017-8748; 1526-4610
• DOI: 10.1111/j.1526-4610.2010.01631.x

(Headache 2010;50:989‐997)
Background.— Medication overuse headache (MOH) is a secondary headache, whose diagnostic criteria were settled by the Second Edition of the International Classification of Headache Disorders and its subsequent revisions. Its diagnosis and treatment represent a growing problem worldwide and a challenge for headache specialists.
Objective.— The aim of this study was to evaluate the efficacy of a therapeutic regimen for withdrawal of the overused drug and prophylaxis of headache in a population of patients suffering from MOH in 8 hospitals of Piemonte – Liguria – Valle d'Aosta.
Patients and Methods.— Seventy patients, 58 females (82.9%) and 12 males (17.1%), mean age at observation 51.04 ± 12.59 years, affected by MOH following International Headache Society diagnostic revised criteria were treated as inpatients (n = 40) or in Day Hospital (n = 30). Headache Index (HI) and Daily Drug Intake (DDI) were used for evaluating the severity of headache and medication overuse. The patients were treated by abrupt discontinuation of the overused drug and by a therapeutic protocol including i.v. hydration, dexhamethasone, metoclopramide, and benzodiazepines for 7‐15 days. Prophylactic medication was started at the beginning of therapeutic protocol. Patients underwent follow‐up controls 1, 3, and 6 months after discharge. The initial diagnosis was MOH in all patients included in the study. The overused medications were simple analgesics in 18 cases (25.7%), combination analgesics in 26 cases (37.1%), triptans alone in 9 cases (12.9%), or in combination with analgesics in 13 cases (18.6%), and ergot derivatives (in combination) in 4 cases (5.7%). We collected data from 59 patients at first follow‐up (1 month), 56 after 3 months, and 42 after 6 months.
Results.— Mean HI was 0.92 at admission, 0.19 at discharge, 0.35 after 30 days, 0.39 after 3 months, and 0.42 after 6 months. Mean DDI was 2.72 at admission, 0.22 at discharge, 0.31 after 1 month, 0.38 after 3 months, and 0.47 after 6 months. These results proved to be highly statistically significant.
Conclusions.— The protocol was generally effective, safe, and well‐tolerated. The results tend to remain stable with time, and seem to be encouraging about long‐term use of this therapeutic protocol on a larger number of patients suffering from MOH.