H C Diener1, F Antonaci2,3, M Braschinsky4, S Evers5,6, R Jensen7, M Lainez8,9, E S Kristoffersen10,11, C Tassorelli2,3, K Ryliskiene12, J A Petersen13. 1. Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany. 2. IRCCS C. Mondino Foundation, Pavia, Italy. 3. Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy. 4. Headache Clinic, Neurology Clinic, Tartu University Hospital, Tartu, Estonia. 5. Faculty of Medicine, University of Münster, Münster, Germany. 6. Krankenhaus Lindenbrunn, Coppenbrügge, Germany. 7. Danish Headache Center, Neurological Clinic, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark. 8. Department of Neurology, Hospital Clínico Universitario, Valencia, Spain. 9. Department of Neurology, Universidad Católica de Valencia, Valencia, Spain. 10. Department of Neurology, Akershus University Hospital, Oslo, Norway. 11. Department of General Practice, University of Oslo, Oslo, Norway. 12. Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. 13. Department Of Neurology, University Hospital Zurich, Zurich, Switzerland.
Abstract
BACKGROUND: The frequent use of medication to treat migraine attacks can lead to an increase in migraine frequency and is called medication-overuse headache (MOH). METHODS: Based on the available literature in this guideline, the first step in patient management is education and counselling. RESULTS: Patients with MOH should be managed by a multidisciplinary team of neurologists or pain specialists and behavioral psychologists. Patients in whom education is not effective should be withdrawn from overused drugs and should receive preventive treatment with drugs of proven efficacy. Patients with MOH in whom preventive treatment is not effective should undergo drug withdrawal. Drug intake can be abruptly terminated or restricted in patients overusing simple analgesics, ergots or triptan medication. In patients with long-lasting abuse of opioids, barbiturates or tranquilizers, slow tapering of these drugs is recommended. Withdrawal can be performed on an outpatient basis or in a daycare or inpatient setting.
BACKGROUND: The frequent use of medication to treat migraine attacks can lead to an increase in migraine frequency and is called medication-overuse headache (MOH). METHODS: Based on the available literature in this guideline, the first step in patient management is education and counselling. RESULTS:Patients with MOH should be managed by a multidisciplinary team of neurologists or pain specialists and behavioral psychologists. Patients in whom education is not effective should be withdrawn from overused drugs and should receive preventive treatment with drugs of proven efficacy. Patients with MOH in whom preventive treatment is not effective should undergo drug withdrawal. Drug intake can be abruptly terminated or restricted in patients overusing simple analgesics, ergots or triptan medication. In patients with long-lasting abuse of opioids, barbiturates or tranquilizers, slow tapering of these drugs is recommended. Withdrawal can be performed on an outpatient basis or in a daycare or inpatient setting.
Authors: Henrik W Schytz; Faisal M Amin; Rigmor H Jensen; Louise Carlsen; Stine Maarbjerg; Nunu Lund; Karen Aegidius; Lise L Thomsen; Flemming W Bach; Dagmar Beier; Hanne Johansen; Jakob M Hansen; Helge Kasch; Signe B Munksgaard; Lars Poulsen; Per Schmidt Sørensen; Peter T Schmidt-Hansen; Vlasta V Cvetkovic; Messoud Ashina; Lars Bendtsen Journal: J Headache Pain Date: 2021-04-08 Impact factor: 7.277
Authors: Hans-Christoph Diener; Peter Kropp; Thomas Dresler; Stefan Evers; Stefanie Förderreuther; Charly Gaul; Dagny Holle-Lee; Arne May; Uwe Niederberger; Sabrina Moll; Christoph Schankin; Christian Lampl Journal: Neurol Res Pract Date: 2022-08-29
Authors: Anna K Eigenbrodt; Håkan Ashina; Sabrina Khan; Hans-Christoph Diener; Dimos D Mitsikostas; Alexandra J Sinclair; Patricia Pozo-Rosich; Paolo Martelletti; Anne Ducros; Michel Lantéri-Minet; Mark Braschinsky; Margarita Sanchez Del Rio; Oved Daniel; Aynur Özge; Ayten Mammadbayli; Mihails Arons; Kirill Skorobogatykh; Vladimir Romanenko; Gisela M Terwindt; Koen Paemeleire; Simona Sacco; Uwe Reuter; Christian Lampl; Henrik W Schytz; Zaza Katsarava; Timothy J Steiner; Messoud Ashina Journal: Nat Rev Neurol Date: 2021-06-18 Impact factor: 42.937