Treatment of medication overuse headache guideline of the efns headache panel

European Journal of Neurology 2011, 18: 1115–1121 E F N S G U I D E L I N E S / C M E A R T I C L E Treatment of medication overuse headache – guideline of theEFNS headache panel S. Eversa and R. JensenbaDepartment of Neurology, University of Mu¨nster, Mu¨nster, Germany; and bDanish Headache Center, Department of Neurology, GlostrupHospital, University of Copenhagen, Copenhagen, Denmark Background: Medication overuse headache is a common condition with a population- based prevalence of more than 1–2%. Treatment is based on education, withdrawal treatment (detoxification), and prophylactic treatment. It also includes management of withdrawal headache.
Aims: This guideline aims to give treatment recommendations for this headache.
Materials and methods: Evaluation of the scientific literature.
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 individualizedprophylactic drug treatment at the first day of withdrawal therapy or even before. Theonly drug with moderate evidence for the prophylactic treatment in patients withchronic 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 pos-sibly effective in the treatment of withdrawal symptoms. Patients after withdrawaltherapy should be followed up regularly to prevent relapse of medication overuse.
Discussion and conclusion: Medication overuse headache can be treated according toevidence-based recommendations.
This guideline aims to give recommendations for the The classification of the IHS provides diagnostic crite- treatment of medication overuse headache (MOH) as ria for chronic headache which is accompanied by the classified by the International Headache Society (IHS) overuse of acute headache drugs such as analgesics, [1]. Although this headache disorder is frequent and a triptans, and opioids (Table 1). In the first edition of major problem in the treatment of patients with chronic the IHS classification, this headache disorder was headache, placebo- or sham-controlled double-blind defined as drug-induced headache implicating that the trials for a specific treatment of this condition are frequent drug intake itself is the cause of the headache almost completely missing. Nearly, all published trials [2]. In the present classification, medication overuse are underpowered or have a high number of dropouts.
with all its somatic and psychological implications is Therefore, these guidelines are based on publications regarded as an association and possibly not the only with a low level of evidence and on expert consensus. A cause of chronic headache [1]. However, it has soon brief clinical description of this potentially preventable become obvious that some subtypes were missing and and treatable type of headache disorder is included.
that headache features of MOH cannot be defined ingeneral. Therefore, a revision of these diagnostic crite-ria was published in 2005 [3]. These criteria are validuntil today although a further revision developed for Correspondence: Prof. S. Evers, MD PhD, Department of Neurology,University of Mu¨nster, Albert-Schweitzer-Str. 33, 48129 Mu¨nster, research purposes has been published in 2006 [4].
Germany (tel.: +49 251 8348196; fax: +49 251 8348181; e-mail The purpose of this article is to give recommenda- tions for the specific management of MOH including This is a Continuing Medical Education article, and can be found with the treatment of withdrawal headache. The recom- corresponding questions on the Internet at http://www.efns.org/EFNS mendations are based on the scientific evidence from Continuing-Medical-Education-online.301.0.html. Certificates forcorrectly answering the questions will be issued by the EFNS.
clinical trials and on the expert consensus by the Ó 2011 The Author(s)European Journal of Neurology Ó 2011 EFNS Table 1 Current diagnostic criteria of the International Headache Society for medication overuse headache (MOH) A. Headachea present on ‡15 days/month fulfilling criteria C and DB. Regular overuseb for ‡3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headachecC. Headache has developed or markedly worsened during medication overuseD. Headache resolves or reverts to its previous pattern within 2 months after discontinuation of overused medicationd aThe headache associated with medication overuse is variable and often has a peculiar pattern with characteristics shifting, even within the sameday, from migraine like to those of tension-type headache.
bOveruse is defined in terms of duration and treatment days per week. What is crucial is that treatment occurs both frequently and regularly, i.e., on2 or more days each week. Bunching of treatment days with long periods without medication intake, practised by some patients, is much less likelyto cause MOH and does not fulfill criterion B.
cMOH can occur in headache-prone patients when acute headache medications are taken for other indications.
dA period of 2 months after cessation of overuse is stipulated in which improvement (resolution of headache, or reversion to its previous pattern)must occur if the diagnosis is to be definite. Prior to cessation, or pending improvement within 2 months after cessation, the diagnosis 8.2.8Probable MOH should be applied. If such improvement does not then occur within 2 months, this diagnosis must be discarded.
Ergotamine intake on ‡10 days/month on a regular basis for >3 months Triptan intake (any formulation) on ‡10 days/month on a regular basis for >3 months Intake of simple analgesics on ‡15 days/month on a regular basis for >3 months Opioid intake on ‡10 days/month on a regular basis for >3 months 8.2.5 Combination analgesic-overuse headache Intake of combination analgesic medicationsa on ‡10 days/month on a regular basis for >3 months 8.2.6 MOH attributed to the combination of acute medications Intake of any combination of ergotamine, triptans, analgesics, and/or opioids on ‡10 days/month on a regular basis for >3 months withoutoveruse of any single class aloneb 8.2.7 Headache attributed to other medication overuse Regular overusec for >3 months of a medication other than those described earlier A. Headache fulfilling criteria A, C, and D for 8.2 MOH B. Medication overuse fulfilling criterion B for any one of the subforms 8.2.1–82.7 1. Overused medication has not yet been withdrawn 2. Medication overuse has ceased within the last 2 months, but headache has not so far resolved or reverted to its previous pattern aCombination typically implicated are those containing simple analgesics combined with opioids, butalbital, and/or caffeine.
bThe specific subform(s) 8.2.1–8.2.5 should be diagnosed if criterion B is fulfilled in respect of any one or more single class(es) of these medications.
cThe definition of overuse in terms of treatment days per week is probably to vary with the nature of the medication.
respective task force of the EFNS. The definitions of headache disorders. In addition, a review book was the recommendation levels follow the EFNS criteria [5].
A literature search was performed using the reference The development of MOH is mainly reported in databases MedLine, Science Citation Index, and the patients with a primary headache disorder such as Cochrane Library; the key words used were ÔheadacheÕ migraine and tension-type headache but has also been together with the term Ômedication overuseÕ or Ôdrug- reported in smaller series of secondary headaches inducedÕ (last search in January 2011). All articles [7–11]. For cluster headache, studies have been pub- lished showing that these patients can also fulfill the considered when they described a controlled trial or a criteria for MOH [12,13]. However, most of these case report or series on the treatment of one of these patients had migraine as a comorbid headache or mi- European Journal of Neurology Ó 2011 EFNS European Journal of Neurology 18, 1115–1121 graine in their family history, and many cluster patients nausea, vomiting, arterial hypotension, tachycardia, with headache take analgesics, ergotamine derivatives, sleep disturbances, restlessness, anxiety, and nervous- or triptans on a daily basis without MOH. Patients with ness. These symptoms normally last between 2 and other pain conditions such as rheumatic diseases and no 10 days but can persist for up to 4 weeks. The with- headache disorder do not develop chronic headache de drawal headache was shorter in patients having taken novo when taking analgesics because of their pain triptans (mean 4.1 days) than ergotamine derivatives (mean 6.7 days) or NSAIDs (mean 9.5 days) [25].
The population-based 1-year prevalence of MOH in The outcome of withdrawal therapy in patients with different countries ranges from 0.7% to 1.7% with a MOH followed up by a neurologist as compared to a female preponderance between 62% and 92% [18].
primary care physician did not differ significantly for The incidence of MOH has not been studied in specific population-based studies. In a study on episodic headache days [26]. Therefore, it is suggested that a migraineurs, the 1-year incidence of chronic headache primary care physician can follow these patients after including MOH was 14% [19]. Amongst all patients in detoxification, which was made in this study in hospital, headache clinics or centers of tertiary care, patients as well as a neurologist or a pain specialist.
with MOH are one of the largest patient group. In With regard to non-pharmacological approaches of Europe up to 30% and in the USA even more than treating MOH, combined short-term psychodynamic 50% of the patients in such centers present with MOH psychotherapy and pharmacological therapy improved [18,20]. In India, for example, only 3.1% of the headache in MOH, and the combination of both had patients in a headache clinic fulfill the criteria for been superior to pharmacological therapy alone for reducing long-term relapses and reduction in quality of In principle, all acute drugs for the treatment of life in a non-randomized study [27]. In another study, headache have been described to cause MOH (i.e., 120 uncomplicated patients with MOH were treated with ergotamine derivatives, barbiturates, triptans, analge- three different modalities: (i) only strong advice to sics both simple and combined, opioids, benzodiaze- withdraw overused medication; (ii) standard outpatient pines; possibly also caffeine). Today, simple analgesics detoxification programme (rapid withdrawal of over- and triptans are the most frequent drugs taken by used medication plus oral prednisolone for 8 days plus personalized prophylactive drugs); (iii) inpatient pro-gramme (rapid withdrawal of overused medication plusoral prednisolone for 8 days plus personalized prophyl- active drugs plus parenteral fluid and antiemetics plus There is evidence, although not overwhelming and close observation for 8 days). The percentages of unanimously shown in prospective trials, that with- patients achieving successful withdrawal and the head- drawal therapy is the best treatment for MOH.
ache frequency were not different between the groups However, all experts and headache centers agree that during the follow-up period of 60 days after withdrawal withdrawal therapy should be offered to patients with MOH. The goal of this treatment is not only to detoxify A direct comparison between inpatient withdrawal the patients and to stop the chronic headache but also, and outpatient withdrawal treatment showed that both probably, to improve responsiveness to acute or pro- methods revealed a significant decrease in headache days per month after 12 months and a reduction in thescores of migraine disability without superiority of onemethod [29]. Following this study, the outpatient with- drawal is less expensive and as successful in a motivated The recommended procedures for withdrawal of patient group than inpatient withdrawal. Advantages of patients with MOH vary, and no study has compared the inpatient withdrawal are the close monitoring of abrupt withdrawal treatment with tapered withdrawal medication intake and the clinical state, professional in prospective randomized trials. Most headache spe- psychological support, an immediate treatment of cialists favor the abrupt discontinuation of pain withdrawal symptoms, and eventually the administra- medication under the impression that abrupt with- tion of intravenous drugs. Overusing opioids, barbitu- drawal is associated with faster resolution of the drug- rates, or benzodiazepines, psychological problems, induced pain-coping behavior [24]. However, tapered severe medical comorbidities, severe withdrawal symp- withdrawal seems to be recommendable for opioids, for toms (e.g., vomiting, status migrainosus), or previous barbiturates, and for benzodiazepines. Main with- medication withdrawal failure are reasons for inpatient drawal symptoms are worsening of the headache, treatment according to expert consensus or national Ó 2011 The Author(s)European Journal of Neurology Ó 2011 EFNS European Journal of Neurology 18, 1115–1121 guidelines [30–32]. However, this recommendation is patients (between 63% and 69% of all patients in the not supported by randomized prospective trials.
different treatment arms) is given, the studies give evi- A recent prospective, multicenter study investigated dence that onabotulinum toxin A is efficacious in the three relatively small groups: (i) only personalized pre- reduction of headache days in MOH. In summary, it is ventive medication from day 1 (n = 17); (ii) abrupt suggested that detoxification prior to initiating pro- withdrawal plus rescue medication (n = 20); (iii) no phylactic therapy may not be required in all patients preventive medication plus no advice to stop overused with MOH [39], whereas other studies support the drugs (n = 19) [33]. The primary end-point, change in importance of initial detoxification [20,23,37].
headache days, did, however, not differ significantlybetween all three groups. Because of the more pro- nounced reduction in the headache index of the firstgroup in comparison with the second group, there Because most drugs helpful for the treatment of with- might be an advantage for a personalized preventive medication without abrupt withdrawal. In another corticosteroids were regarded as an option for the study, advice alone was successful as withdrawal ther- treatment of withdrawal headache [40,41]. The only apy in nearly all patients with simple MOH but sig- controlled, randomized, double-blind study that inves- nificantly less successful in patients with complicated tigated oral prednisolone during the first 6 days after MOH [34]. Further larger, prospective trials are neces- medication withdrawal revealed no effect on a com- bined primary end-point. Of total 97 patients, 49 Studies on a specific preventive therapy of MOH are received prednisolone (60 mg on days 1 and 2, 40 mg missing. Therefore, the choice of the preventive agent in on days 3 and 4, and 20 mg on days 5 and 6) and 48 MOH should be based on the primary headache (e.g., placebo [42]. Conversely, a large open-label trial on migraine vs. tension-type headache), the possible side patients with chronic daily headache and medication effects of the drugs, the comorbidities, and the patientÕs overuse showed that treatment with 60 mg prednisone preference and previous therapeutic experience. Several for 2 days and tapering down by 20 mg every other day open-label trials showed positive effects of different effectively reduced rebound headache and withdrawal substances such as valproic acid and topiramate in the symptoms [43]. Recently, in a small proof-of-concept prophylactic treatment of chronic daily headache with study, nine patients each with MOH received either excessive medication intake. A double-blind trial in placebo or 100 mg prednisone for 5 days [44]. The patients with the specific diagnosis of chronic migraine duration of withdrawal headache was significantly and medication overuse showed a significant reduction lower in the prednisone group as compared to the in the mean number of migraine days per month by placebo group. Taken these results together, there topiramate (range 50–200 mg/day) in comparison with might be an efficacy of corticosteroids on withdrawal placebo ()3.5 ± 6.3 vs. )0.2 ± 4.7; P < 0.05). How- symptoms in patients with MOH but high-quality ever, side effects were reported by 75% of the patients placebo-controlled trials are needed.
in the topiramate group compared with 37% in the There are no other controlled trials on the specific placebo group [35]. The headache reduction was nev- treatment of withdrawal headache or of other symp- ertheless not big enough to change the chronic head- toms during withdrawal therapy. One open study ache into an episodic form. In a similar study on suggested the combination of intravenous hydration, chronic migraine, topiramate achieved a significant dexamethasone, metoclopramide, and benzodiazepines reduction in migrainous days per month by 6.4 as for 7–15 days [41]. Very early studies suggested that compared to placebo which achieved a reduction by also (subcutaneous) sumatriptan, naproxen (500 mg), and amitriptyline (10–50 mg) were effective in amelio- In a large-scale study of 335 patients with MOH from rating withdrawal headache [40,45,46]. However, all the Danish Headache centre, where abrupt detoxifica- these studies were not placebo controlled. Therefore, by tion was initiated, the headache frequency was reduced expert consensus, headache drugs and analgesics are by 67% in migraine patients and by 37% in those with not recommended for the treatment of headache during combined migraine and tension-type headache after a 2- withdrawal therapy except single intravenous adminis- month observation period without prophylactic medi- cation [37]. In a recent project with two large studies onthe efficacy of onabotulinum toxin A in the treatment of chronic migraine, also patients with medication overusewere treated [38]. Although no specific data on the The relapse rate of MOH is about 30% (range between efficacy of onabotulinum toxin in this specific group of 14% and 41%) after 1 year regardless whether inpa- European Journal of Neurology Ó 2011 EFNS European Journal of Neurology 18, 1115–1121 Table 2 Recommendations for the treatment of medication overuse headache (MOH). The level of recommendation is classified as follows Level A: established as effective, ineffective, or harmful by at least one convincing class I study or at least two consistent, convincing class II studiesLevel B: probably effective, ineffective, or harmful by at least one convincing class II study or overwhelming class III evidenceLevel C: possibly effective, ineffective, or harmful by at least two convincing class III studiesGood practice point: lack of evidence but consensus within the task force 1) Patients with MOH should be offered advice and teaching to encourage withdrawal treatment. (B)2) There is no general evidence whether abrupt or tapering withdrawal treatment should be preferred. For the overuse of analgesics, ergotamine derivatives, or triptans, abrupt withdrawal is recommended. For the overuse of opioids, benzodiazepines, or barbiturates, tapering down of themedication should be offered. (good practice point) 3) The type of withdrawal treatment (inpatient, outpatient, advice alone) does not influence the success of the treatment and the relapse rate in 4) In patients with opioid, benzodiazepine, or barbiturate overuse, with severe psychiatric or medical comorbidity or with failure of a previous outpatient withdrawal treatment, inpatient withdrawal treatment should be offered. (good practice point) 5) Individualized preventive medication should be started at the first day of withdrawal treatment or even before if applicable. (C)6) Topiramate 100 mg (up to 200 mg maximum) per day is probably effective in the treatment of MOH. (B)7) Corticosteroids (at least 60 mg prednisone or prednisolone) and amitriptyline (up to 50 mg) are possibly effective in the treatment of withdrawal 8) Patients after withdrawal therapy should be followed up regularly to prevent relapse of medication overuse. (good practice point) tient, outpatient, or advice alone treatment were Specific pattern in children and adolescents applied [18]. Further, the relapse rates do not differsignificantly when a short or a long observation period Several studies showed that MOH also exists in children is used, and most studies indicate that the eventual and adolescents [18]. Population-based epidemiological relapse occurs at an early stage (i.e., within few months) studies detected a 1-year prevalence of 0.3–0.5% in after detoxification. In one study, for example, the adolescents all of them overusing over the counter relapse rate was 23% both after 2 months and after (OTC) analgesics (mainly combined analgesics) [54,55].
1 year in the same sample; [47] in another example, the Children also benefit from withdrawal therapy [56].
relapse rate was 41% after 1 year and 44% after 4 years However, only very few data are available on the best [48]. Overall, the detoxification is fairly successful in treatment in this age group. One month after with- most patients, and all patients with MOH should be drawal therapy, about 53% of all children had a informed and encouraged to discontinue their overuse.
reduction in headache frequency by more than 90% In the general population, simple advice regarding regardless whether they were on preventive medication MOH was sufficient to result in a successful treatment or not; the only predictor for a poor outcome after of MOH in 76% of all patients after 1.5 years [49].
withdrawal therapy was a duration of MOH longer In an Italian study on different ways of withdrawal therapy, a long duration of migraine before medicationoveruse, a higher frequency of migraine after with- drawal therapy, and a greater number of previouspreventive treatments were associated with a higher risk As described earlier, only very few controlled and/or for relapse of MOH [50]. In other studies, predictors of randomized trials are available to give evidence-based relapse were male sex, intake of combination analgesics recommendations for the treatment of MOH. There- after withdrawal therapy, nicotine and alcohol con- fore, the conclusions of this guideline are of low evi- sumption, and taking the former medication again after dence or are good practice points as agreed by expert withdrawal therapy [51,52]. Recently, use of codeine- consensus. A summary of our clinical recommendations containing drugs, low self-reported sleep quality, and high self-reported bodily pain as measured by thequality of life tool SF-36 were predictors for a poor outcome [53]. In some studies, the prognosis was betterfor patients with migraine as the underlying primary 1. Headache Classification Subcommittee. The international headache disorder than for patients with tension-type classification of headache disorders. Cephalalgia 2004;24(Suppl. 1): 1–160.
headache and for ergotamine or triptan withdrawal 2. Headache Classification Committee. Classification and than for analgesic withdrawal [37,48]. It is likely that diagnostic criteria for headache disorders, cranial neuralgias the different results in these studies with respect to and facial pain. Cephalagia 1988; 8(Suppl. 7): 1–96.
predictors of relapse are because of different study 3. Silberstein SD, Olesen J, Bousser MG, et al.; Interna- designs and different background populations.
tional Headache Society The International Classification Ó 2011 The Author(s)European Journal of Neurology Ó 2011 EFNS European Journal of Neurology 18, 1115–1121 of Headache Disorders, 2nd Edition (ICHD-II) – revision 23. Zeeberg P, Olesen J, Jensen R. Discontinuation of medi- of criteria for 8.2 Medication-overuse headache. Cepha- cation overuse in headache patients: recovery of thera- peutic responsiveness. Cephalalgia 2006; 26: 1192–1198.
4. Headache Classification Committee. New appendix cri- 24. Rossi P, Jensen R, Nappi G, Allena M; the COMOES- teria open for a broader concept of chronic migraine.
TAS Consortium. A narrative review on the management of medication overuse headache: the steep road from 5. Brainin M, Barnes M, Baron JC, et al. Guidance for the experience to evidence. J Headache Pain 2009; 10: 407– preparation of neurological management guidelines by EFNS scientific task forces – revised recommendations 25. Katsarava Z, Fritsche G, Muessig M, Diener HC, 2004. Eur J Neurol 2004; 11: 577–581.
Limmroth V. Clinical features of withdrawal headache 6. Olesen J, Goadsby PJ, Ramadan NM, Tfelt-Hansen P, following overuse of triptans and other headache drugs.
Welch KMA, eds. The Headaches, 3rd edn. Philadelphia: 26. Bøe MG, Salvesen R, Mygland A. Chronic daily headache 7. Bauer B, Evers S, Lindo¨rfer HW, Schuierer G, Henning- with medication overuse: predictors of outcome 1 year sen H, Husstedt IW. Headache caused by a sphenoid after withdrawal therapy. Eur J Neurol 2009; 16: 705–712.
mucocele but presenting as an ergotamine-induced head- 27. Altieri M, Di Giambattista R, Di Clemente L, et al.
ache. Headache 1997; 376: 460–462.
Combined pharmacological and short-term psychody- 8. Baandrup L, Jensen R. Chronic post-traumatic headache namic psychotherapy for probable medication overuse – a clinical analysis in relation to the International headache: a pilot study. Cephalalgia 2009; 29: 293–299.
Headache Classification 2nd Edition. Cephalalgia 2005; 28. Rossi P, Di Lorenzo C, Faroni J, Cesarino F, Nappi G.
Advice alone vs. structured detoxification programmes for 9. Wolfe S, Van Stavern G. Characteristics of patients pre- medication overuse headache: a prospective, randomized, senting with ocular pain. Can J Ophthalmol 2008; 43: 432– open-label trial in transformed migraine patients with low medical needs. Cephalalgia 2006; 26: 1097–1105.
10. Cady RK, Schreiber CP. Sinus problems as a cause of 29. Grazzi L, Andrasik F, Usai S, Bussone G. In-patient vs.
headache refractoriness and migraine chronification. Curr day-hospital withdrawal treatment for chronic migraine Pain Headache Rep 2009; 13: 319–325.
with medication overuse and disability assessment: results 11. Willer L, Jensen R, Juhler M. Medication overuse as a at one-year follow-up. Neurol Sci 2008; 29(Suppl. 1): 161– cause of chronic headache in shunted hydrocephalus patients. JNNP 2010; 81: 1261–1264.
30. Paemelaire K, Crevitis L, Goadsby PH, Kaube H. Prac- 12. Evers S, Bauer B, Suhr S. Ergotamine-induced headache tical management of medication overuse headache. Acta associated with cluster headache. Neurology 1996; 46: 31. Obermann M, Katsarava Z. Management of medication 13. Paemeleire K, Bahra A, Evers S, Matharu M, Goadsby overuse headache. Expert Rev Neurother 2007; 7: 1145– PJ. Medication-overuse headache in patients with cluster headache. Neurology 2006; 67: 109–113.
32. Straube A, May A, Kropp P, et al. Therapie prima¨rer 14. Lance F, Parkes C, Wilkinson M. Does analgesic abuse cause headaches de novo? Headache 1988; 28: 61–62.
chronischer Kopfschmerz vom Spannungstyp und andere 15. Wilkinson SM, Becker WJ, Heine JA. Opiate use to control bowel motility may induce chronic daily headache in patients with migraine. Headache 2001; 41: 303–309.
33. Hagen K, Albretsen C, Vilming ST, et al. Management of 16. Bahra A, Walsh M, Menon S, Goadsby PJ. Does chronic medication overuse headache: 1-year randomized multi- daily headache arise de novo in association with regular centre open-label trial. Cephalalgia 2009; 29: 221–232.
use of analgesics? Headache 2003; 43: 179–190.
34. Rossi P, Faroni JV, Nappi G. Short-term effectiveness of 17. Zwart JA, Dyb G, Hagen K, Svebak S, Stovner LJ, simple advice as a withdrawal strategy in simple and Holmen J. Analgesic overuse among subjects with head- complicated medication overuse headache. Eur J Neurol ache, neck, and low-back pain. Neurology 2004; 62: 1540– 35. Diener HC, Bussone G, Van Oene JC, Lahaye M, 18. Evers S, Marziniak M. Clinical features, pathophysiology, Schwalen S, Goadsby PJ; TOPMAT-MIG-201(TOP- and treatment of medication-overuse headache. Lancet CHROME) Study Group. Topiramate reduces headache days in chronic migraine: a randomized, double-blind, 19. Katsarava Z, Schneeweiss S, Kurth T, et al. Incidence and placebo-controlled study. Cephalalgia 2007; 27: 814–823.
predictors for chronicity of headache in patients with 36. Silberstein SD, Lipton RB, Dodick DW, et al.; Topira- episodic migraine. Neurology 2004; 62: 788–790.
mate Chronic Migraine Study Group Efficacy and safety 20. Jensen R, Zeeberg P, Dehlendorff C, Olesen J. Predictors of topiramate for the treatment of chronic migraine: a of outcome of the treatment programme in a multidisci- plinary headache centre. Cephalalgia 2010; 30: 1214–1224.
21. Ravishankar K. Medication overuse headache in India.
37. Zeeberg P, Olesen J, Jensen R. Probable medication- overuse headache: the effect of a 2-month drug-free peri- 22. Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, od. Neurology 2006; 66: 1894–1898.
Lipton RB. Acute migraine medications and evolution 38. Dodick DW, Turkel CC, DeGryse RE, et al. Onabotuli- from episodic to chronic migraine: a longitudinal popu- numtoxinAfortreatmentofchronicmigraine:pooledresults lation-based study. Headache 2008; 48: 1157–1168.
from the double-blind, randomized, placebo-controlled European Journal of Neurology Ó 2011 EFNS European Journal of Neurology 18, 1115–1121 phases of the PREEMPT clinical program. Headache 2010; criteria: 1-year follow-up study (CARE I protocol). Cep- 39. Diener HC, Dodick DW, Goadsby PJ, et al. Utility of 48. Katsarava Z, Muessig M, Dzagnidze A, Fritsche G, topiramate for the treatment of patients with chronic Diener HC, Limmroth V. Medication overuse headache: migraine in the presence or absence of acute medication rates and predictors for relapse in a 4-year prospective overuse. Cephalalgia 2009; 29: 1021–1027.
study. Cephalalgia 2005; 25: 12–15.
40. Bonuccelli U, Nuti A, Lucetti C, Pavese N, DellÕAgnello 49. Grande RB, Aaseth K, Benth JSˇ, Lundqvist C, Russell G, Muratorio A. Amitriptyline and dexamethasone MB. Reduction in medication-overuse headache after combined treatment in drug-induced headache. Cepha- short information. The Akershus study of chronic head- ache. Eur J Neurol 2011; 18: 129–137.
41. Trucco M, Meineri P, Ruiz L, Gionco M; Gruppo Neu- 50. Rossi P, Faroni JV, Nappi G. Medication overuse head- rologico Ospedaliero Interregionale per lo Studio delle ache: predictors and rates of relapse in migraine patients Cefalee (Neurological Hospital Interregional Group for with low medical needs. A 1-year prospective study.
the Study of Headaches). Medication overuse headache: withdrawal and prophylactic therapeutic regimen. Head- 51. Suhr B, Evers S, Bauer B, Gralow I, Grotemeyer KH, Husstedt IW. Drug-induced headache: long-term results 42. Bøe MG, Mygland A, Salvesen R. Prednisolone does not of stationary versus ambulatory withdrawal therapy.
reduce withdrawal headache: a randomized, double-blind 52. Sances G, Ghiotto N, Galli F, et al. Risk factors in 43. Krymchantowski AV, Barbosa JS. Prednisone as initial medication-overuse headache: a 1-year follow-up study treatment of analgesic-induced daily headache. Cephalal- (care II protocol). Cephalalgia 2010; 30: 329–336.
53. Bøe MG, Salvesen R, Mygland A. Chronic daily headache 44. Pageler L, Katsarava Z, Diener HC, Limmroth V.
with medication overuse: a randomized follow-up by Prednisone vs. placebo in withdrawal therapy following neurologist or PCP. Cephalalgia 2009; 29: 855–863.
medication overuse headache. Cephalalgia 2008; 28: 54. Wang SJ, Fuh JL, Lu SR, Juang KD. Chronic daily headache in adolescents: prevalence, impact, and medi- 45. Diener HC, Haab J, Peters C, Ried S, Dichgans J, Pilgrim cation overuse. Neurology 2006; 66: 193–197.
A. Subcutaneous sumatriptan in the treatment of head- 55. Dyb G, Holmen TL, Zwart JA. Analgesic overuse among ache during withdrawal from drug-induced headache.
adolescents with headache: the Head-HUNT-Youth Study. Neurology 2006; 66: 198–201.
46. Hering R, Steiner TJ. Abrupt outpatient withdrawal of 56. Hershey AD. Chronic daily headache in children. Expert medication in analgesic-abusing migraineurs. Lancet 1991; Opin Pharmacother 2003; 4: 485–491.
57. Kossoff EH, Mankad DN. Medication-overuse headache 47. Ghiotto N, Sances G, Galli F, et al. Medication overuse in children: is initial preventive therapy necessary? J Child headache and applicability of the ICHD-II diagnostic Ó 2011 The Author(s)European Journal of Neurology Ó 2011 EFNS European Journal of Neurology 18, 1115–1121

Source: http://www.eaneurology.org/berlin2015/fileadmin/user_upload/guidline_papers/EFNS_guideline_2011_treatment_of_medication_overuse_headache.pdf

prof-harenberg.de

Name der Studie Titel der abgelaufenden klinischen Studien Stand der Studie A Phase 3 Randomized, Double-blind, Parallel-group, Multi-center Study of the Safety and Efficacy of Apixaban for Prophylaxis of Venous Thromboembolism in Acutely III Medical Subjects During and Following HospitalizationA Safety and Efficacy Trial Evaluating the Use of Apixaban for the extended Treatment of Deep

Sx today 5-99**

Louis Miller Wins Common Wealth Award Carver Mead Wins Prestigious Invention Prize the National Institute of Allergy andInfectious Diseases (NIAID), receivedthe 1999 Common Wealth Award forscience at the California Institute ofTechnology, was awarded the 1999 Louis Miller 1965 when he was assigned toBangkok, Thailand, with the U.S. S I G M A X I T O D A Y An Interview with

Copyright © 2014 Medical Pdf Articles