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A Critical Evaluation on MOH Current Treatments.

Andrea Negro1,2, Martina Curto3, Luana Lionetto4

  • 1Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy. andrea.negro@uniroma1.it.

Current Treatment Options in Neurology
|August 16, 2017
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Summary

Chronic migraine (CM) management requires drug withdrawal and a shift to preventative therapy. Early intervention at specialized headache centers is crucial for patients with medication overuse headache (MOH).

Keywords:
Chronic migraineEarly treatmentMedication overuse headacheMigraine acute drugs overuseOnabotulinumtoxinAPreventative therapy

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Area of Science:

  • Neurology
  • Headache Medicine

Background:

  • Migraine is a common neurological disorder; 2.5% of episodic migraine patients develop chronic migraine (CM) annually.
  • Chronic migraine (CM) often leads to overuse of acute pain medications, with ~70% of CM patients at tertiary centers exhibiting medication overuse headache (MOH).
  • MOH management involves education, drug withdrawal/detoxification, and re-prophylaxis.

Purpose of the Study:

  • To review the efficacy of onabotulinumtoxinA for headache prophylaxis in CM patients with MOH.
  • To emphasize the importance of early intervention and preventative strategies in managing CM and MOH.

Main Methods:

  • Review of real-life prospective studies on onabotulinumtoxinA efficacy.
  • Analysis of current management strategies for MOH in CM patients.

Main Results:

  • OnabotulinumtoxinA (155-195 U) shows efficacy in headache prophylaxis for CM with MOH.
  • Drug withdrawal is essential for reducing migraine frequency.
  • Shifting focus from acute pain treatment to headache prevention is critical.

Conclusions:

  • Early referral to tertiary headache centers is vital for CM patients at risk of or with MOH.
  • Prompt drug withdrawal, detoxification, and initiation of preventative therapy are key to successful management.
  • An 'early treatment' approach encompassing referral, withdrawal, and prophylaxis is recommended.