A randomized controlled trial on medication-overuse headache: outcome after 1 and 4 years

Different opinions exist regarding the optimal treatment of patients with medication-overuse headache (MOH). Few studies have evaluated the long-term prognosis among these patients, and there are no standard measures of outcome in such studies.

To summarize the 1- and 4-year outcome of patients with MOH previously included in a randomized follow-up study.

Sixty-one patients with MOH were randomly assigned to receive either preventive treatment from day 1 without detoxification, a standard out patient detoxification program without preventive treatment from day 1, or no specific treatment. Sixty patients still alive were invited to a 4-year follow-up, whereof 50 (83%) participated.

Early introduction of preventive treatment effectively reduced headache days and in particular headache suffering both during the first months and at 12-month follow-up. At 4-year follow-up, 16 persons (32%) were considered as responders (i.e. ≥50% reduction in headache frequency from baseline), whereas 17 persons (34%) met the criteria for MOH. None of the baseline characteristics consistently influenced all five outcome measures.

Early introduction of prophylactic medication was an effective way to reduce headache days during the first 3 months, and the notion that patients with MOH need withdrawal of analgesics to respond to preventive medication seems to be incorrect. The long-term prognosis during the 4-year follow-up was relatively favorable as there was a steady decline in headache, one-third of the patients with MOH having ≥50% reduction in headache frequency from baseline and two-thirds being without medication overuse.