HEADACHE
Medication overuse headache— seeking a management consensus Michael Bjørn Russell
Medication overuse headache (MOH) is a widespread problem, and no global consensus has yet been reached regarding its management. In an attempt to address this issue, six headache centres have collaborated to evaluate a detoxification protocol in a large cohort of patients with MOH from Europe and South America. Russell, M. B. Nat. Rev. Neurol. 10, 309–310 (2014); published online 27 May 2014; doi:10.1038/nrneurol.2014.85
Medication overuse headache (MOH) affects 1–2% of the general population, and is a worldwide challenge owing to the lack of a management consensus. 1 In a study recently published in Cephalalgia, four European and two South American head ache centres collaborated to investigate the effects of a detoxification programme and to evaluate a consensus protocol for the management of MOH.2 MOH is defined in relation to medication intake per month for at least 3 months. Intake of triptans, ergotamine, opioids, combination analgesics or any combination of triptans, ergotamine, opioids, simple analgesics and/ or NSAIDs for ≥10 days per month, or par acetamol, acetylsalicylic acid or NSAIDs for ≥15 days per month, qualify a patient with headache for the diagnosis of MOH.3 The new study enrolled a total of 376 par ticipants who had MOH but were otherwise healthy.2 Previous detoxification, current use of prophylactic migraine medication, alcohol or ‘pure’ opioid overuse were the exclusion criteria. The participants filled in a headache diary for 1 month before receiving advice in relation to detoxification, that is, cessation of medication overuse. Detoxification was supplemented with optional prophylactic migraine medication (not including the drug that had been overused by the patient), and the participants were followed up for an additional 6 months. Participants could be managed either as inpatients or outpatients. The primary end points were the number of headache days per month and the number of medication days per month in each of the observation months as compared
‘‘
…the observed improvement is not likely to be a spontaneous recovery…
’’
with baseline. The secondary end points were percentage of participants who did not complete detoxification, ceased medication overuse, had episodic headache (
Medication overuse headache— seeking a management consensus Michael Bjørn Russell
Medication overuse headache (MOH) is a widespread problem, and no global consensus has yet been reached regarding its management. In an attempt to address this issue, six headache centres have collaborated to evaluate a detoxification protocol in a large cohort of patients with MOH from Europe and South America. Russell, M. B. Nat. Rev. Neurol. 10, 309–310 (2014); published online 27 May 2014; doi:10.1038/nrneurol.2014.85
Medication overuse headache (MOH) affects 1–2% of the general population, and is a worldwide challenge owing to the lack of a management consensus. 1 In a study recently published in Cephalalgia, four European and two South American head ache centres collaborated to investigate the effects of a detoxification programme and to evaluate a consensus protocol for the management of MOH.2 MOH is defined in relation to medication intake per month for at least 3 months. Intake of triptans, ergotamine, opioids, combination analgesics or any combination of triptans, ergotamine, opioids, simple analgesics and/ or NSAIDs for ≥10 days per month, or par acetamol, acetylsalicylic acid or NSAIDs for ≥15 days per month, qualify a patient with headache for the diagnosis of MOH.3 The new study enrolled a total of 376 par ticipants who had MOH but were otherwise healthy.2 Previous detoxification, current use of prophylactic migraine medication, alcohol or ‘pure’ opioid overuse were the exclusion criteria. The participants filled in a headache diary for 1 month before receiving advice in relation to detoxification, that is, cessation of medication overuse. Detoxification was supplemented with optional prophylactic migraine medication (not including the drug that had been overused by the patient), and the participants were followed up for an additional 6 months. Participants could be managed either as inpatients or outpatients. The primary end points were the number of headache days per month and the number of medication days per month in each of the observation months as compared
‘‘
…the observed improvement is not likely to be a spontaneous recovery…
’’
with baseline. The secondary end points were percentage of participants who did not complete detoxification, ceased medication overuse, had episodic headache (
