Medication overuse headache: a pragmatic 5-year, real-world study

Views: 74

Authors

DOI:

https://doi.org/10.48208/HeadacheMed.2025.16

Keywords:

Chronic migraine, Medication-overuse headache, Preventive treatment, Monoclonal antibody

Abstract

Background 

Medication overuse headache (MOH) impacts 1-7% worldwide.  Effective treatment involves the abrupt discontinuation of the overused medication, the implementation of transition therapy during the initial period, and the simultaneous commencement of preventive treatment.

Objective

To describe a 5-year follow-up of patients with chronic migraine and MOH, focusing on the effectiveness of withdrawal treatment, use of traditional preventive medication, and requirement of anti-CGRP monoclonal antibodies.

Method

A single-center, prospective, and descriptive study was conducted. Convenience sampling of consecutive patients diagnosed with chronic migraine and MOH was the inclusion criterion. Demographics and clinical data at baseline, at 12 months, and during a follow-up period of 5 years, were collected in clinical records. The statistical analyses were performed with the Statistical Package for Social Sciences (SPSS®) version 18.2.2.

Results

We were able to follow one hundred and forty patients (116 W, 26 M), ages 18-78 years (mean 42.1±14.3) for 5 years. The diagnosis was carried out 24.9±14.7 years after the onset of the headache, and 6.3±7.6 years, was the time with headache ≥15 days per month. On baseline, the average number of headache days per month (HDM) was 25.2±5.9. There was a meaningful reduction in HDM. At 1 year and 5 years, a ≥ 75% reduction in HDM was observed, respectively, in 51.4% and 70.4% of the sample.

Conclusions

After five years, patients with chronic migraine and MOH who withdrew from excessive medication, used preventive pharmacological agents, and optionally added anti-CGRP monoclonal antibody showed a significant decrease in HDM frequency.

Downloads

Download data is not yet available.

References

Bendtsen L, Munksgaard S, Tassorelli C, Nappi G, Katsarava Z, Lainez M, et al. Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project). Cephalalgia 2014;34:426–33. Doi:10.1177/0333102413515338. DOI: https://doi.org/10.1177/0333102413515338

Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet 2016;388:1545–602. Doi:10.1016/S0140-6736(16)31678-6. DOI: https://doi.org/10.1016/S0140-6736(16)31678-6

Westergaard ML, Glümer C, Hansen EH, Jensen RH. Prevalence of chronic headache with and without medication overuse: Associations with socioeconomic position and physical and mental health status. Pain 2014;155:2005–13. Doi:10.1016/j.pain.2014.07.002. DOI: https://doi.org/10.1016/j.pain.2014.07.002

Krymchantowski A V., Jevoux CC, Krymchantowski AG, Vivas RS, Silva-Néto R. Medication overuse headache: an overview of clinical aspects, mechanisms, and treatments. Expert Rev Neurother 2020;20:591–600. Doi:10.1080/14737175.2020.1770084. DOI: https://doi.org/10.1080/14737175.2020.1770084

Dodick D, Silberstein S. How Clinicians can Detect, Prevent and Treat Medication Overuse Headache. Cephalalgia 2008;28:1207–17. Doi:10.1111/j.1468-2982.2008.01737.x. DOI: https://doi.org/10.1111/j.1468-2982.2008.01737.x

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018;38:1–211. Doi:10.1177/0333102417738202. DOI: https://doi.org/10.1177/0333102417738202

Schwedt TJ, Chong CD. Medication Overuse Headache: Pathophysiological Insights from Structural and Functional Brain MRI Research. Headache: The Journal of Head and Face Pain 2017;57:1173–8. Doi:10.1111/head.13037. DOI: https://doi.org/10.1111/head.13037

May A, Schulte LH. Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol 2016;12:455–64. Doi:10.1038/nrneurol.2016.93. DOI: https://doi.org/10.1038/nrneurol.2016.93

Ashina S, Terwindt GM, Steiner TJ, Lee MJ, Porreca F, Tassorelli C, et al. Medication overuse headache. Nat Rev Dis Primers 2023;9:5. Doi:10.1038/s41572-022-00415-0. DOI: https://doi.org/10.1038/s41572-022-00415-0

Mehta D, de Boer I, Sutherland HG, Pijpers JA, Bron C, Bainomugisa C, et al. Alterations in DNA methylation associate with reduced migraine and headache days after medication withdrawal treatment in chronic migraine patients: a longitudinal study. Clin Epigenetics 2023;15:190. Doi:10.1186/s13148-023-01604-8. DOI: https://doi.org/10.1186/s13148-023-01604-8

Ljubisavljevic S, Ljubisavljevic M, Damjanovic R, Kalinic S. A Descriptive Review of Medication-Overuse Headache: From Pathophysiology to the Comorbidities. Brain Sci 2023;13:1408. Doi:10.3390/brainsci13101408. DOI: https://doi.org/10.3390/brainsci13101408

Tepper SJ. Medication-Overuse Headache. CONTINUUM: Lifelong Learning in Neurology 2012;18:807–22. Doi:10.1212/01.CON.0000418644.32032.7b. DOI: https://doi.org/10.1212/01.CON.0000418644.32032.7b

Katsarava Z, Fritsche G, Muessig M, Diener HC, Limmroth V. Clinical features of withdrawal headache following overuse of triptans and other headache drugs. Neurology 2001;57:1694–8. Doi:10.1212/WNL.57.9.1694. DOI: https://doi.org/10.1212/WNL.57.9.1694

Limmroth V, Katsarava Z, Fritsche G, Przywara S, Diener H-C. Features of medication overuse headache following overuse of different acute headache drugs. Neurology 2002;59:1011–4. Doi:10.1212/WNL.59.7.1011. DOI: https://doi.org/10.1212/WNL.59.7.1011

Bahra A, Walsh M, Menon S, Goadsby PJ. Does Chronic Daily Headache Arise De Novo in Association With Regular Use of Analgesics? Headache: The Journal of Head and Face Pain 2003;43:179–90. Doi:10.1046/j.1526-4610.2003.03041.x. DOI: https://doi.org/10.1046/j.1526-4610.2003.03041.x

Viana M, De Icco R, Allena M, Sances G, Højland JR, Katsarava Z, et al. Clinical Subtypes of Medication Overuse Headache – Findings From a Large Cohort. Headache: The Journal of Head and Face Pain 2019;59:1481–91. Doi:10.1111/head.13641. DOI: https://doi.org/10.1111/head.13641

Jay GW, Barkin RL. Primary Headache Disorders- Part 2: Tension-type headache and medication overuse headache. Disease-a-Month 2017;63:342–67. Doi:10.1016/j.disamonth.2017.05.001. DOI: https://doi.org/10.1016/j.disamonth.2017.05.001

Carlsen LN, Munksgaard SB, Jensen RH, Bendtsen L. Complete detoxification is the most effective treatment of medication-overuse headache: A randomized controlled open-label trial. Cephalalgia 2018;38:225–36. Doi:10.1177/0333102417737779. DOI: https://doi.org/10.1177/0333102417737779

Krymchantowski A, Jevoux C, Krymchantowski AG, Ramos LB, Barbosa JSS, Silva-Neto RP. Medication-overuse headache—a review of different treatment strategies. Frontiers in Pain Research 2023;4. Doi:10.3389/fpain.2023.1103497. DOI: https://doi.org/10.3389/fpain.2023.1103497

Chiang C-C, Schwedt TJ, Wang S-J, Dodick DW. Treatment of medication-overuse headache: A systematic review. Cephalalgia 2016;36:371–86. Doi:10.1177/0333102415593088. DOI: https://doi.org/10.1177/0333102415593088

Krymchantowski A V., Jevoux C da C. Medication-overuse headache. Despite the advances in understanding it, treatment evidence still lacks. Expert Rev Neurother 2017;17:1055–8. Doi:10.1080/14737175.2017.1374173. DOI: https://doi.org/10.1080/14737175.2017.1374173

Krymchantowski A V., Tepper SJ, Jevoux C, Valença M. Medication‐Overuse Headache: Protocols and Outcomes in 149 Consecutive Patients in a Tertiary Brazilian Headache Center. Headache: The Journal of Head and Face Pain 2017;57:87–96. Doi:10.1111/head.12970. DOI: https://doi.org/10.1111/head.12970

Scher AI, Bendtsen L. Patient-Centered Treatment of Chronic Migraine With Medication Overuse. Neurology 2022;98:563–4. Doi:10.1212/WNL.0000000000200252. DOI: https://doi.org/10.1212/WNL.0000000000200252

Schwedt TJ, Hentz JG, Sahai-Srivastava S, Murinova N, Spare NM, Treppendahl C, et al. Patient-Centered Treatment of Chronic Migraine With Medication Overuse. Neurology 2022;98. Doi:10.1212/WNL.0000000000200117. DOI: https://doi.org/10.1212/WNL.0000000000200117

Carlsen LN, Munksgaard SB, Nielsen M, Engelstoft IMS, Westergaard ML, Bendtsen L, et al. Comparison of 3 Treatment Strategies for Medication Overuse Headache. JAMA Neurol 2020;77:1069. Doi:10.1001/jamaneurol.2020.1179. DOI: https://doi.org/10.1001/jamaneurol.2020.1179

Tassorelli C, Jensen R, Allena M, De Icco R, Sances G, Katsarava Z, et al. A consensus protocol for the management of medication-overuse headache: Evaluation in a multicentric, multinational study. Cephalalgia 2014;34:645–55. Doi:10.1177/0333102414521508. DOI: https://doi.org/10.1177/0333102414521508

Krymchantowski A, Moreira P. Out-Patient Detoxification in Chronic Migraine: Comparison of Strategies. Cephalalgia 2003;23:982–93. Doi:10.1046/j.1468-2982.2003.00648.x. DOI: https://doi.org/10.1046/j.1468-2982.2003.00648.x

Grazzi L, Sansone E, Raggi A, D’Amico D, De Giorgio A, Leonardi M, et al. Mindfulness and pharmacological prophylaxis after withdrawal from medication overuse in patients with Chronic Migraine: an effectiveness trial with a one-year follow-up. J Headache Pain 2017;18:15. Doi:10.1186/s10194-017-0728-z. DOI: https://doi.org/10.1186/s10194-017-0728-z

Caronna E, Gallardo VJ, Alpuente A, Torres-Ferrus M, Pozo-Rosich P. Anti-CGRP monoclonal antibodies in chronic migraine with medication overuse: real-life effectiveness and predictors of response at 6 months. J Headache Pain 2021;22:120. Doi:10.1186/s10194-021-01328-1. DOI: https://doi.org/10.1186/s10194-021-01328-1

Diener H-C. Treating medication overuse headache: More than improving headache. Cephalalgia 2014;34:405–6. Doi:10.1177/0333102413515350. DOI: https://doi.org/10.1177/0333102413515350

Munksgaard SB, Bendtsen L, Jensen RH. Treatment‐Resistant Medication Overuse Headache Can Be Cured. Headache: The Journal of Head and Face Pain 2012;52:1120–9. Doi:10.1111/j.1526-4610.2012.02191.x. DOI: https://doi.org/10.1111/j.1526-4610.2012.02191.x

Munksgaard SB, Bendtsen L, Jensen RH. Detoxification of medication-overuse headache by a multidisciplinary treatment programme is highly effective: A comparison of two consecutive treatment methods in an open-label design. Cephalalgia 2012;32:834–44. Doi:10.1177/0333102412451363. DOI: https://doi.org/10.1177/0333102412451363

Diener H-C. How to treat medication overuse headache. Neurology 2007;69:14–5. Doi:10.1212/01.wnl.0000269324.27980.a9. DOI: https://doi.org/10.1212/01.wnl.0000269324.27980.a9

Munksgaard SB, Madsen SK, Wienecke T. Treatment of medication overuse headache—A review. Acta Neurol Scand 2019;139:405–14. Doi:10.1111/ane.13074. DOI: https://doi.org/10.1111/ane.13074

Hagen K, Stovner LJ. A randomized controlled trial on medication-overuse headache: outcome after 1 and 4 years. Acta Neurol Scand 2011;124:38–43. Doi:10.1111/j.1600-0404.2011.01542.x. DOI: https://doi.org/10.1111/j.1600-0404.2011.01542.x

Hagen K, Jensen R, Bøe MG, Stovner LJ. Medication overuse headache: a critical review of end points in recent follow-up studies. J Headache Pain 2010;11:373–7. Doi:10.1007/s10194-010-0221-4. DOI: https://doi.org/10.1007/s10194-010-0221-4

Bøe MG, Thortveit E, Vatne A, Mygland Å. Chronic headache with medication overuse: Long-term prognosis after withdrawal therapy. Cephalalgia 2017;37:1215–21. Doi:10.1177/0333102416672493. DOI: https://doi.org/10.1177/0333102416672493

Krymchantowski AV, Jevoux C da C. The Pharmacological Treatment of Migraine in B razil. Headache: The Journal of Head and Face Pain 2015;55:51–8. Doi:10.1111/head.12513. DOI: https://doi.org/10.1111/head.12513

Krymchantowski A, Jevoux C, Krymchantowski AG, Silva-Néto RP. Medication Overuse Headache, Chronic Migraine and Monoclonal Antibodies Anti-CGRP: A Real-World Study. Clin Neuropharmacol 2023;46:181–5. Doi:10.1097/WNF.0000000000000559. DOI: https://doi.org/10.1097/WNF.0000000000000559

Downloads

Published

2025-06-30

How to Cite

1.
Krymchantowski A, Jevoux C, Krymchantowski AG, Dominguez Moreno R, Silva-Néto RP. Medication overuse headache: a pragmatic 5-year, real-world study. Headache Med [Internet]. 2025 Jun. 30 [cited 2025 Jul. 11];16(2):108-14. Available from: https://www.headachemedicine.com.br/index.php/hm/article/view/1353

Issue

Section

Original