Methylprednisolone plus diazepam i.v. as bridge therapy for medication overuse headache

Abstract

Management of medication overuse headache (MOH) requires abrupt suspension of overused drugs either alone or in association with a detoxification protocol to prevent withdrawal. However, there is no consensus about which suspension strategy is the most effective. Moreover, reliable data about the possible mid-term effect of detoxification are not available. The objective of this study was to evaluate whether a bridge therapy consisting of a 5-day i.v. infusion of methylprednisolone and diazepam determines a significant reduction in headache frequency and drug assumption during the detoxification protocol (day 5) and in the first 3 months in patients with MOH. We conducted a retrospective non-randomized before-and-after study comparing patients with MOH undergoing a bridge therapy protocol (5-day infusion of methylprednisolone, diazepam) with those who refused the treatment and were only recommended to suspend overused painkillers. Both groups started a prophylactic treatment and were followed-up for 3 months. At day 5, 82% of our patients were headache-free; moreover, 48% of the patients did not take any painkiller during the 5-day treatment. Three months after, the intervention group showed a greater reduction of monthly headache days (9.4 vs 3.0) and drugs (19.7 vs 6.5), a greater rate of patients with a ≥ 50% reduction of monthly headaches (p = 0.019) and symptomatic drug consumption (p = 0.000), than the control group. The methylprednisolone and diazepam detoxification protocol reduced headache attacks and drug assumption immediately and in the first 3 months after the intervention, concurring to improve the effect of a new prophylactic therapy.

Intravenous Chlorpromazine as Potentially Useful Treatment for Chronic Headache Disorders

“…15,18 Bridging therapies like prednisone have also been used to treat MOH, in conjunction with withdrawal of the overused medication and preventive treatment. One retrospective study 22 evaluating withdrawal and preventive treatment vs withdrawal, preventive treatment, and a detoxification protocol including methylprednisolone and diazepam, showed a mean reduction of 9.4 headache days in the methylprednisolone group after 3 months, a lower reduction than the one observed in this study (13.5 days). Unfortunately, these findings have not been corroborated in subsequent placebo-controlled, randomized, double-blind studies.…”

Psychopathological Comorbidities and Clinical Variables in Patients With Medication Overuse Headache

“…Detoxification from MOH is a shared but not worldwide standardized practice used by headache units. Nevertheless, wash-out seems a useful protocol for treating medication overuse but only in the short term (Paolucci et al, 2017). There is a need for treating MOH comprehensively, including both a standardized pharmacological protocol and a psychological adequate approach.…”

“…Mean headache frequency and symptomatic drug consumption in the previous 3 months were extracted from the diaries. If patients still overuse painkillers and the MOH diagnosis was confirmed, they had to start a bridge therapy protocol (Paolucci et al, 2017) for helping the withdrawal of symptomatic drugs. The protocol consisted of a 5-day iv infusion of saline solution NaCl 0.9% 250 ml with methylprednisolone 125 mg plus diazepam 10 mg, infused at 100 ml/h, and daily monitoring in a Day Hospital setting.…”

Applicability of DSM-V substance use disorder (SUD) criteria in medication overuse headache (MOH)

“…Elimination or reduction of overuse to less than 2 days per week 6 with or without concomitant preventive medication are widely debated options 7 Many use a bridging therapy to prevent withdrawal symptoms. 8 It is also necessary to refine the meaning and establish the differences between the terms: use, misuse, overuse, abuse, and dependence which are not clearly defined in headache medicine. 9 Only the term overuse appears in the headache classification 2 , but does not appear in the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM).…”