Detoxification in a structured programme is effective for medication-overuse headache

Abstract

Abstract Aim To evaluate the long-term efficacy of two different treatment programmes for medication-overuse headache (MOH) in so-called treatment-resistant patients. Methods MOH patients, who had previously been unsuccessfully treated by neurologists, were enrolled in one of 2 structured detoxification programmes in a tertiary headache centre: (A) a one-week withdrawal with restricted analgesics, rescue medications and prophylactics from Day 1 followed by advice of restricted intake of symptomatic medications or (B) a 2-month drug-free period and multidisciplinary education in groups and subsequent initiation of restricted symptomatic medication and prophylactics as required. All patients were closely followed up for a year. Results 86 of 98 patients completed the 12-month follow-up. Totally, headache frequency was reduced by 39% (p <0.001), medication use by 63% (p <0.001) and 83% remained cured of MOH. Headache frequency was reduced with more than 50% in 42 patients (49%) and 52 (61%) reverted to episodic headache, and with no difference between the groups. Patients in programme B used significantly less symptomatic medication: 6.5 days/4 weeks compared with 8.7 days/4 weeks in programme A (p = 0.02), and the 56% of patients in programme B who needed prophylactic medication was significantly less than the 80% in programme A (p = 0.02). Further, programme B required fewer resources from the staff. Conclusion Structured detoxification with close follow-up by a multidisciplinary team for one year is highly effective in patients with previously treatment-resistant MOH. We recommend a multidisciplinary educational programme for patients in groups due to cost-effectiveness and limited use of medication.