Medication-overuse headache detoxification reduces headache disability - the Akershus study of chronic headache

Medication-overuse headache (MOH) is a chronic headache (≥15 days/month) associated with overuse of acute headache medication. The objective was to investigate headache-related disability before and after self-detoxification from MOH in the general population, as well as possible predictors for successful outcome.

This was a prospective cohort study. Participants were identified in a cross-sectional epidemiological sample of 30 000 persons aged 30-44 from the general Norwegian population. People with MOH received short information about the possible role of medication overuse in headache chronification. A total of 108 of the 128 participants (84%) were eligible for follow-up 1.5 years later.

Using the Migraine Disability Assessment (MIDAS), people with MOH in the general population were heavily disabled (mean MIDAS score 42.1, 95% confidence interval 31.7-52.6) with a majority in the severe disability class. The MIDAS score was significantly reduced at follow-up (P < 0.001) for those with successful self-detoxification. In multivariate analyses, co-occurrence of migraine (P = 0.044) and lower headache frequency at baseline (P = 0.001) increased the odds for successful self-detoxification and reversion to episodic headache.

Medication-overuse headache causes substantial disability in the general population. Self-detoxification leads to reduced headache frequency and disability, although 24% of the participants did not complete self-detoxification. Detoxification should be offered to MOH patients as early as possible with a focus on headache frequency, disability and psychological distress.