The effectiveness of treatments for patients with medication overuse headache

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The effectiveness of treatments for patients with medication overuse headache

Medication overuse headache (MOH) or analgesic rebound headaches or drug-induced headache is a secondary disorder caused by excessive use of acute medications. These were explained  by the International Classification of Headache Disorders 3 (ICDH-3) diagnostic criteria as headache occurring for 15 or more days per month. These occur in patients with a pre-existing headache disorder who has been overusing one or more acute treatment drugs for symptomatic treatment of headache for three or more months, and those headaches cannot be considered for another diagnosis.

About 1–2% of the adult population across the world suffers from chronic headache due to overuse of pain medications. As per the recommendations, acute withdrawal of medications is necessary, but the optimal treatment remains unknown. This study was aimed to evalaute the advantage of treatments for patients with MOH.

An extensive literature search was performed by picking up randomized controlled trials that analyzed interventions for adults suffering from MOH. Two authors estimated the eligible trials and extracted the data. The effect estimates were calculated and used the random effects model for pooled analysis. The primary outcome measures comprised of  ‘headache days’ and ‘days with medications. Outcome data was depicted  as short term (up to 12 weeks) or long term (12 weeks or over).

In this review, 16 trials were considered alongwith 1105 patients. Four trials estimated the use of prednisone with placebo or celecoxib after medication withdrawal, seven trials estimated various methods of withdrawal versus other methods of withdrawal and five trials estimated prophylactic medication compared with placebo or ibuprofen. There were no significant differences in headache days between prednisone versus placebo or between outpatient versus inpatient treatment, but significant difference in days with medication was reported. Altogether, no advantage of prophylactic medication versus placebo was observed.

It was thus culminated that there is low to very low quality of evidence of no benefit of prednisone, prophylaxis and various withdrawal interventions. As the burden of MOH for patients is vast, larger and high quality intervention trials are required.

Source:

Journal of pain

Link to the source:

http://www.jpain.org/article/S1526-5900(16)30357-1/fulltext

Original title of article:

The effectiveness of treatments for patients with medication overuse headache; a systematic review and meta-analysis

Authors:

 Maaike J. de Goffau et al.

Journal of pain
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