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.

A narrative review on the management of medication overuse headache: the steep road from experience to evidence

“…In addition, the level of adherence to treatment was comparable with all three strategies (almost 90% of the initial sample completed the study). These results are in line with those of a previous German study, which suggested that outpatient and inpatient programmes could be equally effective [31]. Sick leave of 1 or 2 weeks may be needed when patients are detoxified in an outpatient setting.…”

“…primary care) of the protocols they suggest remains uncertain. Data from literature indicate that the strategy chosen (outpatient vs. inpatient) is not a significant predictor of the long-term success of withdrawal therapy [31, 32]. …”

Medication overuse as a cause of chronic headache in shunted hydrocephalus patients

“…Our findings in the shunt patients are in accordance with the experience on MOH in non-neurosurgical patients with initial primary or secondary headaches in whom discontinuation of medication overuse segregated the patients in to three groups: 45% improved markedly in frequency, 48% were unchanged and 7% deteriorated slightly 11 15…”

Chronic migraine plus medication overuse headache: two entities or not?

“…Conversely, an outpatient treatment can be an alternative for highly motivated and self-disciplined patients who take a single drug or analgesic not containing barbiturates, and who do not have a high level of depression or anxiety [44, 48–50]. …”

“…Other three studies considering a longer observation period (9–35 months) [50, 57, 58] recorded success rates of 60, 70 and 73%, respectively. Studies with a longer follow-up period (4–6 years) found relapse rates between 40 and 60% [56, 59–61].…”