Abstract

BackgroundDrug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. Still debated is the role of the steroid therapy. The aim of this study was to evaluate the effectiveness of methylprednisolone or paracetamol in the treatment of withdrawal headache in MOH.MethodsWe performed a pilot, randomized, single-blinded, placebo controlled trial. MOH patients, unresponsive to a 3 months prophylaxis, underwent withdrawal therapy on an inpatient basis. Overused medications were abruptly stopped and methylprednisolone 500 mg i.v (A) or paracetamol 4 g i.v. (B) or placebo i.v. (C) were given daily for 5 days. Patients were monitored at 1 and 3 months.ResultsEighty three consecutive MOH patients were enrolled. Fifty seven patients completed the study protocol. Nineteen patients were randomized to each group. Withdrawal headache on the 5th day was absent in 21.0% of group A, in 31.6% of group B and in 12.5% of group C without significant differences. Withdrawal headache intensity decreased significantly after withdrawal without differences among the groups. Rregardless of withdrawal treatment, 52% MOH patients reverted to an episodic migraine and 62% had no more medication overuse after 3 months.ConclusionsThis study suggests that in a population of severe MOH patients, withdrawal headache decreased significantly in the first 5 days of withdrawal regardless of the treatment used. Methylprednisolone and paracetamol are not superior to placebo at the end of the detoxification program.

Highlights

  • Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure

  • All participants suffered from migraine at onset, with a mean age at onset ± standard deviation (SD) was 15.0 ± 7.1 years, and a chronification age of 36.0 ± 9.5 years (Table 1)

  • Education on MOH and drug withdrawal still remain the key elements in the treatment of MOH, but there is no consensus about the withdrawal procedure [4]

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Summary

Introduction

Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. The aim of this study was to evaluate the effectiveness of methylprednisolone or paracetamol in the treatment of withdrawal headache in MOH. MOH affects between 1 and 2% of the general population [3] and 30–50% of patients seen in headache centres. In tertiary headache centres we are used to visit refractory patients with MOH and abrupt drug withdrawal is considered the best treatment [4]. Previous studies have shown that simple information about MOH may be sufficient for Cevoli et al The Journal of Headache and Pain (2017) 18:56 some treatment-naïve patients to stop medication overuse on their own [9,10,11]

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