Diener, Hans-Christoph; Kropp, Peter; Dresler, Thomas; Evers, Stefan; Förderreuther, Stefanie; Gaul, Charly; Holle-Lee, Dagny; May, Arne; Niederberger, Uwe; Moll, Sabrina; Schankin, Christoph; Lampl, Christian (2022). Management of medication overuse (MO) and medication overuse headache (MOH) S1 guideline. Neurological research and practice, 4(1), p. 37. BioMed Central 10.1186/s42466-022-00200-0
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INTRODUCTION
Chronic headache due to the overuse of medication for the treatment of migraine attacks has a prevalence of 0.5-2.0%. This guideline provides guidance for the management of medication overuse (MO) and medication overuse headache (MOH).
RECOMMENDATIONS
Treatment of headache due to overuse of analgesics or specific migraine medications involves several stages. Patients with medication overuse (MO) or medication overuse headache (MOH) should be educated about the relationship between frequent use of symptomatic headache medication and the transition from episodic to chronic migraine (chronification), with the aim of reducing and limiting the use of acute medication. In a second step, migraine prophylaxis should be initiated in patients with migraine and overuse of analgesics or specific migraine drugs. Topiramate, onabotulinumtoxinA and the monoclonal antibodies against CGRP or the CGRP-receptor are effective in patients with chronic migraine and medication overuse. In patients with tension-type headache, prophylaxis is performed with amitriptyline. Drug prophylaxis should be supplemented by non-drug interventions. For patients in whom education and prophylactic medication are not effective, pausing acute medication is recommended. This treatment can be performed in an outpatient, day hospital or inpatient setting. Patients with headache due to overuse of opioids should undergo inpatient withdrawal. The success rate of the stepped treatment approach is 50-70% after 6 to 12 months. A high relapse rate is observed in patients with opioid overuse. Tricyclic antidepressants, neuroleptics (antiemetics) and the administration of steroids are recommended for the treatment of withdrawal symptoms or headaches during the medication pause. Consistent patient education and further close monitoring reduce the risk of relapse.
Item Type: |
Journal Article (Review Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology |
UniBE Contributor: |
Schankin, Christoph Josef |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2524-3489 |
Publisher: |
BioMed Central |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
31 Aug 2022 09:06 |
Last Modified: |
05 Dec 2022 16:23 |
Publisher DOI: |
10.1186/s42466-022-00200-0 |
PubMed ID: |
36031642 |
Uncontrolled Keywords: |
Management Medication overuse Medication overuse headache Migraine Migraine attack |
BORIS DOI: |
10.48350/172492 |
URI: |
https://boris.unibe.ch/id/eprint/172492 |
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