Complete Detoxification Is the Most Effective Treatment of Medication-Overuse Headache

Post on March 29, 2018 by André Broussard, D.C.

March 27, 2018

Cephalalgia: An International Journal of Headache

TAKE-HOME MESSAGE

  • Medication-overuse headache is a common problem encountered in practice. With the dilemma of chronic opioid use becoming a focus of national attention, effective methods of treating medication-overuse headache are important to discuss. The authors of this study argue that there is there is lack of evidence on how to detoxify patients with medication-overuse headaches, and thus they conducted a prospective, outpatient randomized, controlled trial with two detoxification programs. In program A, patients had no analgesics or acute migraine medications, and, in program B, those drugs were restricted to 2 days a week. If preventive medication was needed, it was prescribed. The percentage reduction of headache days per month after 6 months was the primary outcome. In all, 59 patients of the 72 patients enrolled with a primary headache disorder eventually completed the detoxification. Interestingly, results show that the reduction in headache days/month was superior in the patients in group A at 46% (95% CI, 34–58) compared with 22% (95% CI, 11–34) in the patients in program-B (P =. 005). In addition, as expected, the reduction in daily headaches had an impact on migraine days/month, which were reduced by 7.2 in patients in program A (P < .001) and 3.6 in patients in program B (P < .002) after 6 months.
  • While these results should be used with caution and practitioners should establish safety of withdrawal from different types of analgesics used by patients, they are very encouraging, showing that detoxification for medication-overuse headaches works and that complete detoxification is more effective. This provides some management guidance when approaching care of these patients.

    – Omar Iqbal Khan, MD

Abstract

BACKGROUND

There is lack of evidence on how to detoxify medication-overuse headache. Aim To compare the effect of complete stop of acute medication with restricted intake.

METHODS

Medication-overuse headache patients were included in a prospective, outpatient study and randomized to two months’ detoxification with either a) no analgesics or acute migraine-medication (program A), or b) acute medication restricted to two days/week (program B). Detoxification was followed by preventives if indicated. Patients were followed up at 2, 6 and 12 months. Percentage reduction in headache days/month after 6 months was the primary outcome.

RESULTS

We included 72 medication-overuse headache patients with a primary migraine and/or tension-type headache diagnosis. Fifty-nine completed detoxification, 58 (81%) were followed up at month 6 and 53 (74%) at month 12. At month 6, program A reduced headache days/month by 46% (95% CI 34-58) compared with 22% (95% CI 11-34) in program-B ( p = 0.005), and 70% in program A versus 42% in program B were reverted to episodic headache ( p = 0.04). Migraine-days/month were reduced by 7.2 in program A ( p < 0.001) and 3.6 in program B ( p = 0.002) after 6 months.

CONCLUSION

Both detoxification programs were very effective. Detoxification without analgesics or acute migraine-medication was the most effective program.

Journal Abstract

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