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 language | English |
|---|---|
| Article number | 56 |
| Pages (from-to) | 1-9 |
| Journal | Journal of Headache and Pain |
| Volume | 18 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Dec 1 2017 |
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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 journal › Article
}
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 -