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Chronic migraine plus medication overuse headache: two entities or not?
Andrea Negro1, Paolo Martelletti
1Department of Medical and Molecular Sciences, Sapienza University, Rome, Italy. andrea.negro@uniroma1.it
The Journal of Headache and Pain
|September 23, 2011
Summary
Chronic migraine (CM) management involves drug withdrawal and detoxification. OnabotulinumtoxinA shows efficacy for re-prophylaxis in CM patients, even with medication overuse headache (MOH).
Area of Science:
- Neurology
- Headache Medicine
Background:
- Chronic migraine (CM) is an evolution of episodic migraine, often leading to medication overuse headache (MOH).
- Transition to frequent attacks is influenced by lifestyle, genetics, and comorbidities.
Purpose of the Study:
- To review management strategies for CM, particularly when complicated by MOH.
- To highlight effective re-prophylaxis treatments post-detoxification.
Main Methods:
- Review of CM and MOH management, focusing on drug withdrawal and detoxification.
- Evaluation of therapeutic agents for re-prophylaxis, including onabotulinumtoxinA and topiramate.
- Analysis of data from the PREEMPT clinical program for CM and MOH patients.
Main Results:
- Drug withdrawal and detoxification are crucial first steps in managing CM with MOH.
- OnabotulinumtoxinA and topiramate demonstrated efficacy in re-prophylaxis after detoxification.
- OnabotulinumtoxinA offers a better adverse event profile and is highly beneficial for CM patients, including those with MOH.
Conclusions:
- OnabotulinumtoxinA is an effective treatment for CM, with or without MOH, offering a favorable safety profile.
- The PREEMPT program provides guidance for onabotulinumtoxinA administration in CM patients.
- Effective management of CM with MOH requires a multi-faceted approach including detoxification and targeted re-prophylaxis.
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