Pilot Study of Amitriptyline in the Prophylactic Treatment of Medication-Overuse Headache: A 1-Year Follow-Up

Fan, Wen; Lv, Yuhua; Ying, Guomin; Li, Wangwen; Zhou, Jiying

doi:10.1111/pme.12517

Cited by 10 publications

(5 citation statements)

References 34 publications

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“…MOH is treatable with detoxification as recommended by the European guidelines (2), but there is lack of consensus on how to perform the detoxification. Different approaches to detoxification programs have been suggested: Simultaneous preventive medication, prednisone treatment, rehydration and in-or out-patient programs (3)(4)(5)(6)(7)(8)(9)(10). Most programs allowed restricted intake of acute headache medication during detoxification to relieve withdrawal symptoms (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Complete detoxification is the most effective treatment of medication-overuse headache: A randomized controlled open-label trial

et al. 2017

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Background There is lack of evidence on how to detoxify medication-overuse headache. Aim To compare the effect of complete stop of acute medication with restricted intake. Methods Medication-overuse headache patients were included in a prospective, outpatient study and randomized to two months' detoxification with either a) no analgesics or acute migraine-medication (program A), or b) acute medication restricted to two days/week (program B). Detoxification was followed by preventives if indicated. Patients were followed up at 2, 6 and 12 months. Percentage reduction in headache days/month after 6 months was the primary outcome. Results We included 72 medication-overuse headache patients with a primary migraine and/or tension-type headache diagnosis. Fifty-nine completed detoxification, 58 (81%) were followed up at month 6 and 53 (74%) at month 12. At month 6, program A reduced headache days/month by 46% (95% CI 34-58) compared with 22% (95% CI 11-34) in program-B ( p = 0.005), and 70% in program A versus 42% in program B were reverted to episodic headache ( p = 0.04). Migraine-days/month were reduced by 7.2 in program A ( p < 0.001) and 3.6 in program B ( p = 0.002) after 6 months. Conclusion Both detoxification programs were very effective. Detoxification without analgesics or acute migraine-medication was the most effective program. Trial registration Clinicaltrials.gov (NCT02903329).

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Section: Introductionmentioning

confidence: 99%

Complete detoxification is the most effective treatment of medication-overuse headache: A randomized controlled open-label trial

et al. 2017

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“…Addition of atorvastatin in migraineurs' preventive regimen was associated with a responder rate of 65% during the two months of study and a mean reduction of 3 migraine attacks per month. These amounts in previous studies were 50% for propranolol (32), amitriptyline (33), sodium valproate and divalproex and 40% for candesartan (34). Patient satisfaction, as an indicator of quality care, was significantly higher in intervention group.…”

Section: Discussionmentioning

confidence: 70%

Does Atorvastatin Help Prevent Classic Migraine Attacks? A Triple-Blind Controlled Clinical Trial

Ganji¹,

Majdinasab²,

Hesam³

et al. 2020

Preprint

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Background: Migraine is a painful and disabling nervous disorder which negatively affects the quality of life. Migraineurs may suffer from a generalized vasomotor dysfunction. Statins improve vasomotor and vascular function, with their pleiotropic effects. We aimed to assess efficacy and safety of adding Atorvastatin to prophylactic regimen in better control of classic migraine.Methods: This triple-blind controlled clinical trial was on 68 consecutive patients with history of classic migraine. An interval of at least one month was given to evaluate vitamin D3 level and eligibility. In patients with vitamin D3 deficiency, the correction was provided by administration of soft gelatin capsule of vitamin D supplementation. The patients were randomly assigned to receive atorvastatin 20mg plus sodium valproate 500mg or placebo plus sodium valproate 500mg once a day for two months. The patients were evaluated based for the number of attacks and pain severity based on Visual Analogue Scale. Results: There was a significant (p = 0.0001) improvement in severity of pain and number of migraine attacks by adding Atorvastin to the prophylactic regimen of patients. After controlling for variable parameters, the differences between two arms of the study was yet statistically significant (p = 0.0001). A significant number of participants in intervention group were satisfied by their treatment (p = 0.001). There was no remarkable difference in two arms of the study in terms of possible side effects (P =0.315).Conclusions: The results of present study suggested that adding atorvastatin to migraine preventive regimen may help reduce the number of acute attacks and pain severity. This modality did not cause considerable side effects and led to a better patient satisfaction.

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“…A 58% of the patients were considered to be responders, 73% continued without drug abuse. 29 In adults with CM and MOH, we recommend to immediately initiate individualized prophylactic treatment in addition to discontinuation of the drug of abuse for headache improvements (strong recommendation, high quality of evidence, 1A). A systemic review showed that prophylactic treatment from the first day of suspension of the drug of abuse versus late initiation of preventive treatment 2 months later induced a reduction in headache frequency in days/months at 1-year follow-up.…”

Section: Discontinuing Medication Overuse In CM Patients and Additional Preventive Measures To Avoid Headachesmentioning

confidence: 99%

Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

Vélez-Jiménez

Chiquete-Anaya

Orta

et al. 2021

Cephalalgia Reports

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Introduction: Migraine is a polygenic multifactorial disorder with a neuronal initiation of a cascade of neurochemical processes leading to incapacitating headaches. Headaches are generally unilateral, throbbing, 4–72 h in duration, and associated with nausea, vomiting, photophobia, and sonophobia. Chronic migraine (CM) is the presence of a headache at least 15 days per month for ≥3 months and has a high global impact on health and economy, and therapeutic guidelines are lacking. Methods: Using the Grading of Recommendations, Assessment, Development, and Evaluations system, we conducted a search in MEDLINE and Cochrane to investigate the current evidence and generate recommendations of clinical practice on the identification of risk factors and treatment of CM in adults. Results: We recommend avoiding overmedication of non-steroidal anti-inflammatory drugs (NSAIDs); ergotamine; caffeine; opioids; barbiturates; and initiating individualized prophylactic treatment with topiramate eptinezumab, galcanezumab, erenumab, fremanezumab, or botulinum toxin. We highlight the necessity of managing comorbidities initially. In the acute management, we recommend NSAIDs, triptans, lasmiditan, and gepants alone or with metoclopramide if nausea or vomiting. Non-pharmacological measures include neurostimulation. Conclusions: We have identified the risk factors and treatments available for the management of CM based on a grading system, which facilitates selection for individualized management.

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Pilot Study of Amitriptyline in the Prophylactic Treatment of Medication-Overuse Headache: A 1-Year Follow-Up

Abstract: Given these results, early introduction of low-dose amitriptyline combined with abrupt withdrawal could be considered as a choice for patients with MOH.

Cited by 10 publications

References 34 publications

Complete detoxification is the most effective treatment of medication-overuse headache: A randomized controlled open-label trial

Complete detoxification is the most effective treatment of medication-overuse headache: A randomized controlled open-label trial

Does Atorvastatin Help Prevent Classic Migraine Attacks? A Triple-Blind Controlled Clinical Trial

Comprehensive management of adults with chronic migraine: Clinical practice guidelines in Mexico

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