Treatment of medication overuse headache- guideline of the EFNS headache panel

European Journal of Neurology, 08/15/2011

LastName FI et al. (Type summary here)

Methods

  • Evaluation of the scientific literature was done.

Results

  • Abrupt withdrawal or tapering down of overused medication is recommended, the type of withdrawal therapy is probably not relevant for the outcome of the patient.
  • However, inpatient withdrawal therapy is recommended for patients overusing opioids, benzodiazepine, or barbiturates.
  • It is further recommended to start individualized prophylactic drug treatment at the first day of withdrawal therapy or even before.
  • The only drug with moderate evidence for the prophylactic treatment in patients with chronic migraine and medication overuse is topiramate up to 200 mg.
  • Corticosteroids (at least 60 mg prednisone or prednisolone) and amitriptyline (up to 50 mg) are possibly effective in the treatment of withdrawal symptoms.
  • Patients after withdrawal therapy should be followed up regularly to prevent relapse of medication overuse.

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