Physicians should discontinue medication to treat medication-overuse headache

Researchers found better outcomes when physicians discontinued overused medication when patients presented with medication-overuse headache, according to research presented at the American Academy of Neurology annual meeting.

Chia-Chun Chiang, MD, a researcher for the Mayo Clinic, and colleagues, said that physicians should also add preventive medication.

"In this review, we provide an analysis of the evidence regarding different treatment strategies for medication-overuse headache," Chiang told Healio Internal Medicine. "Due to the absence of controlled studies, the level of evidence to support early discontinuation of overused medications is class III. For patients with chronic migraine and medication overuse, there are large randomized control trials supporting the use of onabotulinumtoxinA and topiramate without early discontinuation of overuse; however, the data were obtained from post hoc analyses and therefore represent class II level evidence."

The researchers analyzed 68 studies on PubMed published between 2004 and 2014 that evaluated medication overuse headache treatment. They specifically investigated several treatment strategies: Discontinuation of overused medication, discontinuation of overused medication plus adding preventive medication, and use of preventive medication without discontinuation of overused medication.

Results showed that studies that assessed the discontinuation of overused medication plus adding preventive medication reported better outcomes when compared with only discontinuing overused medication.

"Based on current available evidence, recommended limits on the use of acute headache medication, and the systemic toxicity of overusing acute headache medication, we suggest discontinuation of the overused medication, use of alternative acute medication with a maximum limit of 9 treatment days per month, and the addition of preventive medication," Chiang said. "Appropriately sized, randomized controlled trials evaluating the safety and long-term efficacy of preventive medication plus early discontinuation of overuse vs preventive medication alone are needed." – by Chelsea Frajerman Pardes

Reference:

Chiang CC, et al. Treatment of medication-overuse headache: A systematic review. Presented at: American Academy of Neurology Annual Meeting; April 15-21, 2016; Vancouver, British Columbia.

Disclosures: Chiang reports no relevant financial disclosures. Please see the full abstract for a complete list of all other authors' relevant financial disclosures.