Treatment of withdrawal headache in patients with medication overuse headache: a pilot study

Sabina Cevoli, Giulia Giannini, Valentina Favoni, Rossana Terlizzi, Elisa Sancisi, Marianna Nicodemo, Stefano Zanigni, Maria Letizia Bacchi Reggiani, Giulia Pierangeli, Pietro Cortelli

Research output: Contribution to journalArticle

Abstract

Background: Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. Still debated is the role of the steroid therapy. The aim of this study was to evaluate the effectiveness of methylprednisolone or paracetamol in the treatment of withdrawal headache in MOH. Methods: We performed a pilot, randomized, single-blinded, placebo controlled trial. MOH patients, unresponsive to a 3 months prophylaxis, underwent withdrawal therapy on an inpatient basis. Overused medications were abruptly stopped and methylprednisolone 500 mg i.v (A) or paracetamol 4 g i.v. (B) or placebo i.v. (C) were given daily for 5 days. Patients were monitored at 1 and 3 months. Results: Eighty three consecutive MOH patients were enrolled. Fifty seven patients completed the study protocol. Nineteen patients were randomized to each group. Withdrawal headache on the 5th day was absent in 21.0% of group A, in 31.6% of group B and in 12.5% of group C without significant differences. Withdrawal headache intensity decreased significantly after withdrawal without differences among the groups. Rregardless of withdrawal treatment, 52% MOH patients reverted to an episodic migraine and 62% had no more medication overuse after 3 months. Conclusions: This study suggests that in a population of severe MOH patients, withdrawal headache decreased significantly in the first 5 days of withdrawal regardless of the treatment used. Methylprednisolone and paracetamol are not superior to placebo at the end of the detoxification program.

Original languageEnglish
Article number56
Pages (from-to)1-9
JournalJournal of Headache and Pain
Volume18
Issue number1
DOIs
Publication statusPublished - Dec 1 2017

Fingerprint

Secondary Headache Disorders
Headache
Methylprednisolone
Acetaminophen
Placebos
Therapeutics
Migraine Disorders
Inpatients
Steroids

Keywords

  • Detoxification
  • Medication overuse headache
  • Migraine

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Treatment of withdrawal headache in patients with medication overuse headache : a pilot study. / Cevoli, Sabina; Giannini, Giulia; Favoni, Valentina; Terlizzi, Rossana; Sancisi, Elisa; Nicodemo, Marianna; Zanigni, Stefano; Bacchi Reggiani, Maria Letizia; Pierangeli, Giulia; Cortelli, Pietro.

In: Journal of Headache and Pain, Vol. 18, No. 1, 56, 01.12.2017, p. 1-9.

Research output: Contribution to journalArticle

Cevoli, S, Giannini, G, Favoni, V, Terlizzi, R, Sancisi, E, Nicodemo, M, Zanigni, S, Bacchi Reggiani, ML, Pierangeli, G & Cortelli, P 2017, 'Treatment of withdrawal headache in patients with medication overuse headache: a pilot study', Journal of Headache and Pain, vol. 18, no. 1, 56, pp. 1-9. https://doi.org/10.1186/s10194-017-0763-9
Cevoli, Sabina ; Giannini, Giulia ; Favoni, Valentina ; Terlizzi, Rossana ; Sancisi, Elisa ; Nicodemo, Marianna ; Zanigni, Stefano ; Bacchi Reggiani, Maria Letizia ; Pierangeli, Giulia ; Cortelli, Pietro. / Treatment of withdrawal headache in patients with medication overuse headache : a pilot study. In: Journal of Headache and Pain. 2017 ; Vol. 18, No. 1. pp. 1-9.
@article{b4424292c1f542bd85198ac2aa661528,
title = "Treatment of withdrawal headache in patients with medication overuse headache: a pilot study",
abstract = "Background: Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. Still debated is the role of the steroid therapy. The aim of this study was to evaluate the effectiveness of methylprednisolone or paracetamol in the treatment of withdrawal headache in MOH. Methods: We performed a pilot, randomized, single-blinded, placebo controlled trial. MOH patients, unresponsive to a 3 months prophylaxis, underwent withdrawal therapy on an inpatient basis. Overused medications were abruptly stopped and methylprednisolone 500 mg i.v (A) or paracetamol 4 g i.v. (B) or placebo i.v. (C) were given daily for 5 days. Patients were monitored at 1 and 3 months. Results: Eighty three consecutive MOH patients were enrolled. Fifty seven patients completed the study protocol. Nineteen patients were randomized to each group. Withdrawal headache on the 5th day was absent in 21.0{\%} of group A, in 31.6{\%} of group B and in 12.5{\%} of group C without significant differences. Withdrawal headache intensity decreased significantly after withdrawal without differences among the groups. Rregardless of withdrawal treatment, 52{\%} MOH patients reverted to an episodic migraine and 62{\%} had no more medication overuse after 3 months. Conclusions: This study suggests that in a population of severe MOH patients, withdrawal headache decreased significantly in the first 5 days of withdrawal regardless of the treatment used. Methylprednisolone and paracetamol are not superior to placebo at the end of the detoxification program.",
keywords = "Detoxification, Medication overuse headache, Migraine",
author = "Sabina Cevoli and Giulia Giannini and Valentina Favoni and Rossana Terlizzi and Elisa Sancisi and Marianna Nicodemo and Stefano Zanigni and {Bacchi Reggiani}, {Maria Letizia} and Giulia Pierangeli and Pietro Cortelli",
note = "Ricercatori distaccati presso IRCCS a seguito Convenzione esclusiva con Universit{\`a} di Bologna (Pierangeli Giulia, Cortelli Pietro)",
year = "2017",
month = "12",
day = "1",
doi = "10.1186/s10194-017-0763-9",
language = "English",
volume = "18",
pages = "1--9",
journal = "Journal of Headache and Pain",
issn = "1129-2369",
publisher = "BioMed Central Ltd.",
number = "1",

}

TY - JOUR

T1 - Treatment of withdrawal headache in patients with medication overuse headache

T2 - a pilot study

AU - Cevoli, Sabina

AU - Giannini, Giulia

AU - Favoni, Valentina

AU - Terlizzi, Rossana

AU - Sancisi, Elisa

AU - Nicodemo, Marianna

AU - Zanigni, Stefano

AU - Bacchi Reggiani, Maria Letizia

AU - Pierangeli, Giulia

AU - Cortelli, Pietro

N1 - Ricercatori distaccati presso IRCCS a seguito Convenzione esclusiva con Università di Bologna (Pierangeli Giulia, Cortelli Pietro)

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background: Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. Still debated is the role of the steroid therapy. The aim of this study was to evaluate the effectiveness of methylprednisolone or paracetamol in the treatment of withdrawal headache in MOH. Methods: We performed a pilot, randomized, single-blinded, placebo controlled trial. MOH patients, unresponsive to a 3 months prophylaxis, underwent withdrawal therapy on an inpatient basis. Overused medications were abruptly stopped and methylprednisolone 500 mg i.v (A) or paracetamol 4 g i.v. (B) or placebo i.v. (C) were given daily for 5 days. Patients were monitored at 1 and 3 months. Results: Eighty three consecutive MOH patients were enrolled. Fifty seven patients completed the study protocol. Nineteen patients were randomized to each group. Withdrawal headache on the 5th day was absent in 21.0% of group A, in 31.6% of group B and in 12.5% of group C without significant differences. Withdrawal headache intensity decreased significantly after withdrawal without differences among the groups. Rregardless of withdrawal treatment, 52% MOH patients reverted to an episodic migraine and 62% had no more medication overuse after 3 months. Conclusions: This study suggests that in a population of severe MOH patients, withdrawal headache decreased significantly in the first 5 days of withdrawal regardless of the treatment used. Methylprednisolone and paracetamol are not superior to placebo at the end of the detoxification program.

AB - Background: Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. Still debated is the role of the steroid therapy. The aim of this study was to evaluate the effectiveness of methylprednisolone or paracetamol in the treatment of withdrawal headache in MOH. Methods: We performed a pilot, randomized, single-blinded, placebo controlled trial. MOH patients, unresponsive to a 3 months prophylaxis, underwent withdrawal therapy on an inpatient basis. Overused medications were abruptly stopped and methylprednisolone 500 mg i.v (A) or paracetamol 4 g i.v. (B) or placebo i.v. (C) were given daily for 5 days. Patients were monitored at 1 and 3 months. Results: Eighty three consecutive MOH patients were enrolled. Fifty seven patients completed the study protocol. Nineteen patients were randomized to each group. Withdrawal headache on the 5th day was absent in 21.0% of group A, in 31.6% of group B and in 12.5% of group C without significant differences. Withdrawal headache intensity decreased significantly after withdrawal without differences among the groups. Rregardless of withdrawal treatment, 52% MOH patients reverted to an episodic migraine and 62% had no more medication overuse after 3 months. Conclusions: This study suggests that in a population of severe MOH patients, withdrawal headache decreased significantly in the first 5 days of withdrawal regardless of the treatment used. Methylprednisolone and paracetamol are not superior to placebo at the end of the detoxification program.

KW - Detoxification

KW - Medication overuse headache

KW - Migraine

UR - http://www.scopus.com/inward/record.url?scp=85019228299&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019228299&partnerID=8YFLogxK

U2 - 10.1186/s10194-017-0763-9

DO - 10.1186/s10194-017-0763-9

M3 - Article

C2 - 28500492

AN - SCOPUS:85019228299

VL - 18

SP - 1

EP - 9

JO - Journal of Headache and Pain

JF - Journal of Headache and Pain

SN - 1129-2369

IS - 1

M1 - 56

ER -