BASH Guideline

At 8 weeks following medication withdrawal 45% of patients report improvement in headaches while in 48 % the headaches remain unchanged (Zeeberg et al., 2006b) (though it must be noted that this data is from a single trial).

Between 22 – 45% patients relapse back into MOH within 1 year, and 40 – 60% within 4 years of withdrawing from their overused medications (Fritsche & Diener, 2002; Katsarava et al., 2005).

The relapse rate is lower for patients with migraine and for individuals overusing triptans rather than analgesics (21% vs 71%) (Katsarava et al., 2005).

Comorbid anxiety and depression can be associated with difficulty in medication withdrawal and a high risk of relapse following withdrawal of medication (Radat & Lanteri-Minet, 2010).

Response to migraine preventive medications improves following withdrawal of the overused acute headache medication (Bigal & Lipton, 2006; Zeeberg et al., 2006b).

There is no difference in outcome if preventive medication is started during or after withdrawal, as long as the acute medication is withdrawn. Preventive treatment is more effective once the overused medication is withdrawn (Kudrow, 1982; Rossi et al., 2008; Silberstein et al., 2007; Zeeberg et al., 2006a).

The most important step in MOH management is to identify the diagnosis and inform the patient of the importance of reducing or stopping the offending medication, and no further measures may then be required (Cevoli et al., 2017; Olesen, 2012; Rossi et al., 2011).