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Complete withdrawal is the most effective approach to reduce disability in patients with medication-overuse headache: A randomized controlled open-label trial

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DOI

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  1. The effect of pituitary adenylate cyclase-activating peptide-38 and vasoactive intestinal peptide in cluster headache

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Neurofilament light chain as biomarker in idiopathic intracranial hypertension

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  3. Comparison of 3 Treatment Strategies for Medication Overuse Headache: A Randomized Clinical Trial

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BACKGROUND: Medication-overuse headache leads to high disability and decreased quality of life, and the best approach for withdrawal has been debated.

AIM: To compare change in disability and quality of life between two withdrawal programs.

METHODS: We randomized medication-overuse headache patients to program A (two months without acute analgesics or migraine medications) or program B (two months with acute medications restricted to two days/week) in a prospective, outpatient study. At 6 and 12 months, we measured disability and headache burden by the Headache Under-Response to Treatment index (HURT). We estimated quality of life by EUROHIS-QOL 8-item at 2-, 6-, and 12-month follow-up. Primary endpoint was disability change at 12 months.

RESULTS: We included 72 medication-overuse headache patients with primary migraine and/or tension-type headache. Fifty nine completed withdrawal and 54 completed 12-month follow-up. At 12-month follow-up, 41 patients completed HURT and 38 completed EUROHIS-QOL 8-item. Disability reduction was 25% in program-A and 7% in program-B ( p = 0.027). Headache-burden reduction was 33% in program-A and 3% in program-B ( p = 0.005). Quality of life was increased by 8% in both programs without significant difference between the programs ( p = 0.30). At 2-month follow-up, quality of life increased significantly more in program-A than program-B ( p = 0.006).

CONCLUSION: Both withdrawal programs reduced disability and increased quality of life. Withdrawal without acute medication was the most effective in reducing disability in medication-overuse headache patients.

TRIAL REGISTRATION: Clinicaltrials.gov (NCT02903329).

Original languageEnglish
JournalCephalalgia : an international journal of headache
Volume39
Issue number7
Pages (from-to)863-872
ISSN0333-1024
DOIs
Publication statusPublished - 2019

ID: 56703816