Drug-induced headache: long-term results of stationary versus ambulatory withdrawal therapy

Abstract

Drug-induced headache is a well-known complication of the treatment of primary headache disorders, and its successful management is only possible by withdrawal therapy. However, it is unknown whether ambulatory or stationary withdrawal is the therapy preferred. We conducted a prospective study on the outcome of stationary versus ambulatory withdrawal therapy in patients with drug-induced headache according to the International Headache Society criteria. Out of 257 patients with the diagnosis of drug-induced headache during the study period, 101 patients (41 after ambulatory and 60 after stationary withdrawal therapy) could be followed up for 5.9 +/- 4.0 years. The total relapse rate after successful withdrawal therapy was 20.8% (14.6% after ambulatory and 25.0% after stationary withdrawal therapy, p < 0.2). The main risk factors for a relapse were male sex (OR = 3.9, CI = 1.3-11.6), intake of combined analgesic drugs (OR = 3.8, CI = 1.4-10.3), administration of naturopathy (OR = 6.0, CI = 1.2-29.3), and a trend to tension-type headache as the primary headache disorder (OR = 1.9, CI = 0.6-53.0). Our data suggest that neither the method of withdrawal therapy nor the kind of analgesic and other antimigraine drugs has a major impact on the long-term result after successful withdrawal therapy. Patients with risk factors according to our findings should be informed and monitored regularly, and combined drugs should be avoided. Furthermore, our data suggest that there is a need for research on individual psychological and behavioral risk factors for relapse after successful withdrawal therapy in drug-induced headache.

Drug-Induced Headache: Long-Term Follow-Up of Withdrawal Therapy and Persistence of Drug Misuse

“…The success rate of a withdrawal therapy varies according to the time window of the follow-up period: after 0.5 years 73% of the patients showed a reduction of headache days of more than 50% [3], after 3 years about 60% [7]. The relapse rate is about 20–40% [8, 9]. …”

“…While a meta-analysis (29 studies) has been published investigating the first aspect [3], only five studies refer to the second and third aspects [6, 7, 9, 10, 11]. Sufficient relevance to the current situation can only be seen in the studies performed by Suhr et al [9]and Schnider et al [11]. …”

Chronic daily headache: how to manage it?

“…The duration of chronic drug overuse was found by some authors to be a significant parameter [27][28][29]; for example, the type of analgesic abused was relevant in maintaining CDH and drug abuse [29][30][31]. On the other hand, others did not find any significant prognostic factor for long-term outcome in CDH patients [32,33].…”

Headache of Analgesic Abuse as a Cause of New Pain Pathways Development

“…When the disorder of MOH and drug-induced headache presents, the main treatment must be treatment withdrawal and even then the discussion on what is the best withdrawal method (stationary vs. ambulatory) still remains inconclusive [110]; as a preventive strategy, drug combinations must be avoided as much as possible and high-risk patients who develop MOH must be regularly evaluated to ensure that no late complications are showing up during long-term treatment. …”