Withdrawal failure in patients with chronic migraine and medication overuse headache

Abstract

Objectives The management of chronic migraine (CM) with Medication Overuse Headache (MOH) consists of withdrawal therapy, education on medications’ use and prescription of prophylaxis. Little attention has been given to patients who fail in achieving a successful short‐term outcome after withdrawal: we aim to describe predictors of failure. Methods Patients with CM and MOH were enrolled at the Neurological Institute C. Besta of Milano, and included if they completed the three months follow‐up. Withdrawal failure was defined as the situation in which patients either did not revert from chronic to episodic migraine (EM), were still overusing acute medications, or both did not revert to EM and kept overusing acute medications. Predictors of failure were addressed with a logistic regression, and for all variables, the longitudinal course in the two groups was described. Results In 39, out of 137 patients, withdrawal was unsuccessful: the predictors included day‐hospital‐based withdrawal (OR: 2.37; 95% CI: 1.06–5.29), emergency room (ER) access before withdrawal (OR: 2.81; 95% CI: 1.13–6.94) and baseline headache frequency >69 days/three months (OR: 2.97; 95% CI: 1.32–6.65). Patients who failed withdrawal did not improve on medications intake, use of prophylactic and non‐pharmacological treatments, symptoms of anxiety and depression. Conclusions Patients who were treated in day‐hospital, those who recently attended ER for headache, and those with more than 69 headache/3 months, as well as to those with relevant symptoms of anxiety and depression who did not improve should be closely monitored to reduce likelihood of non‐improvement after structured withdrawal.

A Preliminary Analysis on the Feasibility and Short-Term Efficacy of a Phase-III RCT on Mindfulness Added to Treatment as Usual for Patients with Chronic Migraine and Medication Overuse Headache

“…It has to be acknowledged that this evaluation was performed at three months from the structured in-hospital withdrawal, which acts on three aspects: withdrawal from overused drugs, prescription of tailored prophylaxis, and education on lifestyle and on the use of drugs. Achieving such results on drug intake should be the “normal” outcome in such a short period; in reports based upon three-month evaluation, we found that 72% to 84% of patients achieve successful withdrawal outcome by three months (i.e., acceptable headache frequency and/or absence of medication overuse [ 43 , 44 ]). Our results, in addition to reaching an acceptable level of NSAID and triptan consumption, also demonstrate that the reduction in NSAIDs was significantly larger.…”

The World Health Organization Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders and the headache revolution: from headache burden to a global action plan for headache disorders

“…Nevertheless, evidence on the occurrence of headaches, and migraine in particular, in association with several risk factors exists, and some of these risk factors (e.g. sleep hygiene, adequate hydration, moderate physical activity, control over medications intake) are part of the indication given to patients as part of patients' education, in particular for the treatment of chronic headaches [103,104].…”

Complicated Form of Medication Overuse Headache Is Severe Version of Chronic Migraine

“…The high frequency of headaches and the lack of effective prophylactic treatment trigger the use of symptomatic medication. Studies have shown that the intensive use of symptomatic treatment activates certain pain mechanisms that lead to the chronicization of pain [8,9]. In some studies, it has been noted that excessive use of symptomatic treatment, such as in osteoarticular diseases, does not lead to MOH, while in patients primarily with migraine, excessive medication usage is observed to be associated with headaches [10].…”