The Evolution of Medication Overuse Headache: History, Pathophysiology and Clinical Update

Sun-Edelstein, Christina; Rapoport, Alan M.; Rattanawong, Wanakorn; Srikiatkhachorn, Anan

doi:10.1007/s40263-021-00818-9

Cited by 33 publications

(61 citation statements)

References 141 publications

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“…Some evidence on the efficacy of the anti-CGRP mAbs as preventive agents in patients affected by CM with MOH comes from post-hoc analysis of the RCTs that has led to the approval of erenumab ( 8 ), fremanezumab ( 9 ) and galcanezumab ( 14 ). However, the additional benefit of in-hospital abrupt overused drug(s) discontinuation preceding the start of anti-CGRP mAbs was never investigated ( 11 ); hence, our study is the first to specifically address this issue. MOH is a very disabling condition which impacts significantly on both disability and the economic burden of patients.…”

Section: Discussionmentioning

confidence: 99%

“…An effective preventive treatment, irrespective of the detoxification strategy, as shown by anti-CGRP mAbs in our preliminary results, would significantly impact on MOH management and costs which are currently challenging most of the public health systems worldwide. Biologic underpinnings which may explain a different action profile of anti-CGRP mAbs on MOH compared to the other preventive migraine medications still need to be fully elucidated ( 11 ). Hints may come from the acute anti-CGRP therapies, namely gepants, which have shown both preclinical and clinical evidence of a reduced potential MOH risk profile.…”

Section: Discussionmentioning

confidence: 99%

“…Underpinnings of this result remain largely unknown. However, analgesics and triptans exposure results in up-regulation of CGRP in the trigeminal root ganglion and blood ( 11 ); hence, patients with elevated MPMI may have a higher enhancement of the CGRP system, potentially reflecting a higher propensity to respond to anti-CGRP therapies. Notably, neither the higher number of treatment failures nor MOH duration were associated with anti-CGRP treatment responses, further confirming the effectiveness of this medication class in difficult-to-treat migraine patients.…”

Section: Discussionmentioning

confidence: 99%

“…The advent of monoclonal antibodies (mAbs) against calcitonin gene-related peptide (CGRP) or its receptor has been revolutionizing both episodic and chronic migraine management, with potential huge impact also on MOH ( 8 , 9 ). Indeed, preliminary evidence suggest that this medication class may be effective in CM complicated by MOH, regardless of previous painkiller(s) withdrawal ( 8 – 11 ). Studies specifically aimed at evaluating such results have been warranted in order to inform both treatment and underlying pathophysiological mechanisms ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache

et al. 2022

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Background Medication overuse headache significantly contributes to the chronification process and treatment refractoriness of migraine. Currently, abrupt discontinuation of the overused medication still represents the best management strategy for these patients, challenging public health system resources. Methods In this prospective study, chronic migraine and medication overuse headache sufferers with at least 28 days of analgesic consumption per month were included. Assessment of efficacy outcomes at three months were compared among patients who underwent in-hospital abrupt discontinuation of overused acute medication (YES-DETOX group) and patients who did not (NO-DETOX group) before starting an anti-CGRP monoclonal antibody. Results Of 401 patients who received either erenumab or galcanezumab, 28% (n = 111) satisfied inclusion criteria (YES-DETOX n = 28; NO-DETOX n = 83). After three months of treatment, 59% (n = 65; 47/83 YES-DETOX; 18/28 NO-DETOX) patients reverted from medication overuse headache and 51% (n = 57; 42/83 YES-DETOX; 15/28 NO-DEOTX) achieved ≥50% reduction in monthly headache days; yet no statistical differences were observed between the two groups (p = 0.4788 and p = 0.8393, respectively). Monthly consumption of pain medication was the only baseline prognostic factor in multivariate analysis in the overall cohort (p = 0.016). Conclusion Our results support the emerging evidence that anti-CGRP monoclonal antibodies may be effective in medication overuse headache patients irrespective of detoxification, yet further studies are needed to draw definitive conclusions.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache

et al. 2022

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“…International Classification of Headache Disorders-3rd edition (ICHD-3) defines CM as headache occurring on ≥15 days/month for more than 3 months, having features of migraine headache on at least 8 days/month (2). Many patients with CM also have a secondary headache in the form of medication overuse headache (MOH) because of frequent use of analgesics, ergots, triptans, and opioids (3). ICHD-3 allows concurrent diagnosis of MOH with CM (2).…”

Section: Introductionmentioning

confidence: 99%

Efficacy and tolerability of combination treatment of topiramate and greater occipital nerve block versus topiramate monotherapy for the preventive treatment of chronic migraine: A randomized controlled trial

et al. 2022

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Objective To compare the efficacy and tolerability of combination treatment of topiramate and greater occipital nerve block to topiramate monotherapy in adult chronic migraine patients. Background Options for the preventive treatment of chronic migraine are limited and costly. Combination treatments do not have an evidence base yet. Methods This was a parallel group, 3 arms with 1:1:1 allocation ratio randomized controlled study in consecutive adult chronic migraine patients attending Headache Clinic in a tertiary care hospital. Patients received either topiramate monotherapy 100 mg/day (group A), or topiramate plus greater occipital nerve block with 40 mg lidocaine (2%) and 80mg (2 ml) methylprednisolone as the first injection followed by monthly injections of lidocaine for the next 2 months (group B) or topiramate plus greater occipital nerve block with 40 mg lidocaine (2%) injections monthly for 3 months (group C). The primary endpoint was the mean change in monthly migraine days at Month 3. Multiple secondary endpoints were assessed that included among others, achievement of ≥50% reduction in mean monthly headache days compared to baseline at Month 3 and assessment for any adverse events. Results One hundred and twenty-five patients were randomized; 41 to group A, 44 to group B, and 40 to group C. Efficacy assessments were done for 121 patients. Patients receiving combination treatment of topiramate and greater occipital nerve block with steroids and lidocaine and greater occipital nerve block with only lidocaine compared to topiramate monotherapy showed greater reductions in monthly migraine days at Month 3 (−9.6 vs −7.3 days; p = 0.003) and (−10.1 vs −7.3 days; p < 0.001) respectively. Greater proportion of patients in both the combination treatment groups (added greater occipital nerve block with and without steroid) achieved ≥50% reduction in mean monthly headache days [71.4% vs 39%; OR (95% CI) 3.9(1.6–9.8); p = 0.004] and [62.4% vs 39%; OR (95% CI) 2.7(1.1–6.7); p = 0.034] respectively, compared to those receiving topiramate monotherapy. Adverse effects between the groups were comparable although patients receiving combination treatment with added greater occipital nerve block reported transient adverse effects like post-injection dizziness, local site swelling, and pain. No serious adverse event was reported. Conclusion Combination treatments of topiramate with monthly injections of greater occipital nerve block were more effective in reducing monthly migraine days in chronic migraine than topiramate monotherapy at Month 3. Combination treatments were well tolerated.

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Galcanezumab for the treatment of chronic migraine and medication overuse headache: Real‐world clinical evidence in a severely impaired patient population

et al. 2023

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Background Galcanezumab is a monoclonal antibody acting against the calcitonin gene‐related peptide approved for the preventive treatment of migraine. The aim of this article is to explore its effectiveness and safety of galcanezumab in chronic migraine (CM) with medication overuse‐headache (MOH). Methods Seventy‐eight patients were consecutively enrolled at the Modena headache center and followed up for 15 months. Visits were scheduled every 3 months, and the following variables were collected: the number of migraine days per month (MDM); the painkillers taken per month (PM); the number of days per month in which the patient took, at least, one painkiller; the six‐item headache impact test; and the migraine disability assessment questionnaire (MIDAS) score. Demographic features of the analyzed sample were collected at the baseline and adverse events (AEs) were collected at every visit. Results After 12 months, galcanezumab significantly reduced the MDM, the PM, the number of days on medication, the HIT‐6 as well as the MIDAS scores (all p < .0001). The greatest amelioration was obtained in the first trimester of treatment. A higher MDM, a higher NRS score at the baseline, and a higher number of failed preventive treatments negatively predict the CM relief at the year of treatment. No serious AEs were registered and only one drop‐out was due to AE. Conclusions Galcanezumab is effective and safe for the treatment of patients affected by CM and MOH. Patients with a higher impairment at the baseline may found less benefits with galcanezumab.

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The Evolution of Medication Overuse Headache: History, Pathophysiology and Clinical Update

Cited by 33 publications

References 141 publications

Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache

Detoxification vs non-detoxification before starting an anti-CGRP monoclonal antibody in medication overuse headache

Efficacy and tolerability of combination treatment of topiramate and greater occipital nerve block versus topiramate monotherapy for the preventive treatment of chronic migraine: A randomized controlled trial

Galcanezumab for the treatment of chronic migraine and medication overuse headache: Real‐world clinical evidence in a severely impaired patient population

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