BASH Guideline
Section 1: The Clinical Approach
Section 2: Primary Headaches
2.2 Medication overuse headache
2.2.3 Management
A) Patient education
An important aspect in the management of MOH is to increase awareness of the condition amongst health care providers as well as the general population.
Patients must be advised that restricting their acute headache medications to no more than 2 days in a week minimizes the potential of developing MOH (Dodick & Silberstein, 2008).
Educational intervention is crucial and results in improvement in headache (Grande et al., 2011).
Comparison of advice alone with a structured detoxification program in patients with MOH is similarly effective (Rossi et al., 2006).
The use of rescue medications, including steroids, does not improve outcomes (Bøe et al., 2007; Pageler et al., 2004; Rabe et al., 2013; Rossi et al., 2006).
Patients should be encouraged to seek preventive treatments for migraine as this can prevent the conversion from episodic to chronic migraine thereby reducing the risk of development of MOH (Limmroth et al., 2007).
B) Medication withdrawal
The MOH is unlikely to resolve unless the offending medication is stopped (Zeeberg et al., 2006b).
There is no difference in outcome with either abrupt or gradual withdrawal of the causative drug (Rossi et al., 2009).
Outpatient medication withdrawal is as effective as inpatient detoxification (Krymchantowski & Moreira, 2003; Rossi et al., 2006; Tassorelli et al., 2014).
Withdrawal headache usually lasts for 2-10 days from the time of complete cessation of the overused medication (Diener & Limmroth, 2004; Silverman et al., 1992; van Dusseldorp & Martijn, 1990).
After medication withdrawal patient’s headaches gradually improved. This improvement can take up to 12 weeks (Mathew et al., 1990).
The average duration of withdrawal headache appears to be shortest in patients overusing triptans (4 days) (Katsarava et al., 2001).
Response to acute and preventive medications improves following withdrawal of the overused medication (Kudrow, 1982; Zeeberg et al., 2006b).