The effect of a drug-free period on probable medication overuse headache

Medication overuse headaches get better by merely discontinuing the overused drug, even if no prophylactic treatment is given, according to the results of a prospective study.Authors of the study say that the classification of medication overuse headache is based on the assumption that medication overuse transforms and aggravates primary headache, and that removing the medication should lead to improvements. However, few headache clinics keep their patients drug-free during the two-month diagnosis period, and it remains uncertain whether patients get better by discontinuing the drug and with nothing else.The authors analysed prospectively-collected data from patients treated in 2002 and 2003 at the Danish Headache Centre, a tertiary referral headache centre. From a total of 1,326 patients, 337 (25%) had probable MOH headache. In these patients, all acute headache medication was discontinued abruptly and patients were kept medication-free for 2 months as part of the general treatment program. A total of 216 patients stayed medication-free for 2 months. Within this cohort, 45% of the patients improved, 48% had no changes, and 7% had more headaches after the 2-month drug-free period. The authors report, "The relative reduction in headache frequency varied considerably between the diagnostic groups and was in favour of a migraine diagnosis, with a 67% median reduction in pure migraine, 37% in the combination of migraine and TTH ?Etension-type headache?I and 0% in pure TTH and the group of other headaches."The authors emphasise that their results were due to simply withdrawing the overused drug and that any eventual benefits of prophylactic therapy were not assessed. "Assuming that medication overuse nullifies the effect of prophylactic agents, the possibility of a satisfactory long-term treatment outcome exists also in the patients who had no initial reduction in headache frequency," they say.Reference...