Research
Print page Print page
Switch language
Rigshospitalet - a part of Copenhagen University Hospital
E-pub ahead of print

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

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Association Between Sumatriptan Treatment During a Migraine Attack and Central 5-HT1B Receptor Binding

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Diagnostic Value of Cerebrospinal Fluid Neurofilament Light Protein in Neurology: A Systematic Review and Meta-analysis

    Research output: Contribution to journalReviewResearchpeer-review

  3. Serum Neurofilament Light Chain for Prognosis of Outcome After Cardiac Arrest

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Effect of Infusion of Calcitonin Gene-Related Peptide on Cluster Headache Attacks: A Randomized Clinical Trial

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Persistent post-traumatic headache attributed to mild traumatic brain injury: Deep phenotyping and treatment patterns

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Episodic and Chronic Cluster Headache: Differences in Family History, Traumatic Head Injury, and Chronorisk

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Monitoring chronic headache and medication-overuse headache prevalence in Denmark

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Diagnostic delay of cluster headache: A cohort study from the Danish Cluster Headache Survey

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Guide to preclinical models used to study the pathophysiology of idiopathic intracranial hypertension

    Research output: Contribution to journalReviewResearchpeer-review

View graph of relations

Importance: Medication overuse headache (MOH) is a disabling, globally prevalent disorder representing a well-known and debated clinical problem. Evidence for the most effective treatment strategy is needed.

Objective: To compare 3 treatment strategies for MOH.

Design, Setting, and Participants: This open-label, randomized clinical trial with 6 months of follow-up was conducted in the tertiary sector at the Danish Headache Center, Glostrup, from October 25, 2016, to June 28, 2019. Of 483 patients with MOH referred during the inclusion period, 195 met the criteria consisting of migraine and/or tension-type headache, 18 years or older, eligibility for outpatient treatment, no severe physical or psychiatric disorder, no other addiction, and not pregnant or breastfeeding. Of these, 75 refused participation and 120 were included. Data were analyzed from July 3 to September 6, 2019.

Interventions: Random assignment (1:1:1 allocation) to 1 of the 3 outpatient treatments consisting of (1) withdrawal plus preventive treatment, (2) preventive treatment without withdrawal, or (3) withdrawal with optional preventive treatment 2 months after withdrawal.

Main Outcomes and Measures: The primary outcome was change in headache days per month after 6 months. Predefined secondary outcomes were change in monthly migraine days, use of short-term medication, pain intensity, number of responders, patients with remission to episodic headache, and cured MOH.

Results: Of 120 patients, 102 (mean [SD] age, 43.9 [11.8] years; 81 women [79.4%]) completed the 6-month follow-up. Headache days per month were reduced by 12.3 (95% CI, 9.3-15.3) in the withdrawal plus preventive group, by 9.9 (95% CI, 7.2-12.6) in the preventive group, and by 8.5 (95% CI, 5.6-11.5) in the withdrawal group (P = .20). No difference was found in reduction of migraine days per month, use of short-term medication, or headache intensity. In the withdrawal plus preventive group, 23 of 31 patients (74.2%) reverted to episodic headache, compared with 21 of 35 (60.0%) in the preventive group and 15 of 36 (41.7%) in the withdrawal group (P = .03). Moreover, 30 of 31 patients (96.8%) in the withdrawal plus preventive group were cured of MOH, compared with 26 of 35 (74.3%) in the preventive group and 32 of 36 (88.9%) in the withdrawal group (P = .03). These findings corresponded to a 30% (relative risk, 1.3; 95% CI, 1.1-1.6) increased chance of MOH cure in the withdrawal plus preventive group compared with the preventive group (P = .03).

Conclusion and Relevance: All 3 treatment strategies were effective, but based on these findings, withdrawal therapy combined with preventive medication from the start of withdrawal is recommended as treatment for MOH.

Trial Registration: ClinicalTrials.gov Identifier: NCT02993289.

Original languageEnglish
JournalJAMA Neurology
ISSN2168-6149
DOIs
Publication statusE-pub ahead of print - 2020

ID: 60053091