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Discontinuation of medication overuse in headache patients: recovery of therapeutic responsiveness

Authors


Peter Zeeberg MD, Danish Headache Centre, Department of Neurology, University of Copenhagen, Glostrup Hospital, Nordre Ringvej 57, DK-2600 Glostrup, Denmark. Tel. + 45 4323 3071, fax + 45 4323 3839, e-mail peter.zeeberg@dadlnet.dk

Abstract

It is generally accepted that ongoing medication overuse nullifies the effect of prophylactic treatment, although few data support this contention. We set out to describe the treatment outcome in patients withdrawn from medication overuse and relate any improvement to a renewed effect of prophylaxis. For patients with probable medication-overuse headache (pMOH), treated and dismissed from the Danish Headache Centre in 2002 and 2003, we assed, from prospective headache diaries, the headache frequency before and after withdrawal of offending drugs and compared these frequencies with the headache frequency at dismissal. Among 1326 patients, 337 had pMOH. Eligible were 175, mean age 49 years, male/female ratio 1 : 2.7. Overall, there was a 46% decrease in headache frequency from the first visit to dismissal (< 0.0001). Patients with no improvement 2 months after complete drug withdrawal (N = 88) subsequently responded to pharmacological and/or non-pharmacological prophylaxis with a 26% decrease in headache frequency as measured from the end of withdrawal to dismissal (< 0.0001). At dismissal, 47% were on prophylaxis. Former non-responders to medical prophylaxis had a 49% decrease in headache frequency from first visit to dismissal (< 0.0001), whereas those who had never received prophylaxis had a 56% reduction (< 0.0001). This difference was not statistically significant (= 0.22). Almost all MOH patients benefit from drug withdrawal, either just from the withdrawal or by transformation from therapeutic non-responsiveness to responsiveness. According to the International Classification of Headache Disorders, 2nd edn, the MOH diagnosis requires improvement after drug withdrawal. Our data suggest that these diagnostic criteria are too strict.

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