Modulation of central sensitisation by detoxification in MOH: Results of a 12-month detoxification study

Abstract

The central nervous system is sensitised in patients with MOH. For the first time we demonstrate that the pain perception continues to normalise up to a year after detoxification. This emphasises the importance of detoxification and follow-up to prevent relapse.

Pain modulation is affected differently in medication-overuse headache and chronic myofascial pain – A multimodal MRI study

“…MOH is defined as headache that develops or significantly worsens during overuse of acute pain medication (3). During medication overuse, pain thresholds in cephalic and extracephalic regions were found to be reduced in animal and human studies, probably because of drug-induced latent sensitisation of the trigeminovascular system (4,5), which was reversible after detoxification. Alterations in central modulation of trigeminal nociceptive input have been proposed in the pathophysiology of MOH.…”

Medication overuse and chronic migraine: a critical review according to clinical pharmacology

“…To support this hypothesis, using positron emission tomography with 18-F-fluorodeoxyglucose (FDG-PET), a reversible metabolic change in the structures of pain processing and persistent orbitofrontal hypofunction have been observed in migraine patients with MOH [66]. Central sensitization suggested by preclinical research could however be a consequence of chronic pain [63,67].…”

“…Chronic migraine should therefore become episodic again, in the case of real MOH, and the response to preventive and attack treatments should improve. To support this rationale, it has been observed that in successfully detoxified patients the pain threshold (measured by pressure pain threshold) increases and the level of central sensitization characterizing chronic pain decreases [67].…”

“…Waiting could be the right choice for patients with a short history of disorder, well motivated, and less severe. Furthermore, it is thought that prophylactic treatment works better if the patient discontinues drug overuse before [67].…”

Practical issues of management of patients with chronic migraine. Recommendations from Russian experts

“…Из половины этих пациентов, которые возобновляют лечение или начи-нают прием другого препарата после повторной кон-сультации врача, 87 % снова прекращают лечение в течение года [18]. В то же время регресс центральной сенситизации -основного патофизиологического механизма хронической боли, оцениваемый по нор-мализации болевой перцепции -происходит посте-пенно в течение не менее 1 года, что было доказано динамикой болевых порогов при ХМ с лекарственным абузусом после курса детоксикационной терапии на фоне профилактического лечения [19].…”