Short-term effectiveness of simple advice as a withdrawal strategy in simple and complicated medication overuse headache
Article first published online: 13 JUL 2010
© 2010 The Author(s). European Journal of Neurology © 2010 EFNS
European Journal of Neurology
Volume 18, Issue 3, pages 396–401, March 2011
How to Cite
Rossi, P., Faroni, J. V. and Nappi, G. (2011), Short-term effectiveness of simple advice as a withdrawal strategy in simple and complicated medication overuse headache. European Journal of Neurology, 18: 396–401. doi: 10.1111/j.1468-1331.2010.03157.x
- Issue published online: 17 FEB 2011
- Article first published online: 13 JUL 2010
- Received 2 March 2010 Accepted 14 June 2010
- drug withdrawal;
- medication overuse headache;
Background and purpose: The aim of this study was to compare the effectiveness of intensive advice (to withdraw the overused medication/s) as a withdrawal strategy in patients with simple and complicated medication overuse headache (MOH).
Methods: One hundred consecutive MOH patients were included in the study. Exclusion criteria were co-existent severe medical or psychiatric illnesses, treatment with migraine prophylactic drugs within the past 3 months, and overuse of opioids and/or barbiturate-containing agents. MOH was defined as complicated in patients fulfilling at least one of the following criteria: (i) a diagnosis of co-existent, significant, and complicating medical illnesses; (ii) a current diagnosis of mood disorder, anxiety disorder, eating disorder, or substance addiction disorder; (iii) a relapse after previous detoxification treatment; (iv) psycho-social and environmental problems; and (v) daily use of multiple doses of symptomatic medication/s. Withdrawal therapy was considered successful if, after 2 months, the patient had had reverted to an intake of NSAIDs lower than 15 days/month or to an intake of other symptomatic medication/s lower than 10 days/month.
Results: Fifty-one patients had simple MOH and 49 patients had complicated MOH. Eleven patients failed to attend follow-up visits (simple MOH = 3, complicated MOH = 8, P > 0.05). Of all the patients included in the study, we were able to detoxify 79% (92.1% of the patients with simple MOH and 65.3% of those with complicated MOH, P < 0.01).
Conclusions: Simple advice is highly effective in simple MOH and effective in most complicated MOH patients and should be regarded as the first step in a step-care approach to MOH management.