Natural History of Abortive Medication Withdrawal in the Management of Pediatric Medication Overuse Headache
Emily L Pierce1, Alexandra A Mandel2, Jeffrey A Strelzik1
1Department of Neurology, Children's National Hospital, Washington, DC, USA.
Insights
Discontinuing overused headache medications can significantly improve pain in pediatric patients. Most children experienced headache resolution within 8 days of stopping medication, showing reduced pain intensity.
Area of Science:
- Neurology
- Pediatrics
- Clinical Pharmacology
Background:
- Medication overuse headache (MOH) is a common condition in children and adolescents.
- Abruptly discontinuing the overused medication is a primary strategy for managing MOH.
Purpose of the Study:
- To document pain scores during the withdrawal of abortive medications in pediatric patients diagnosed with medication overuse headache.
- To assess the effectiveness of medication withdrawal in improving headache characteristics in this population.
Main Methods:
- A cross-sectional study was conducted at Children's National Hospital's Headache Program.
- Patients aged 6-18 years with presumed MOH were instructed to abruptly discontinue overused medications and record headache details daily for 8 weeks.
- Fourteen patient diaries were analyzed at a 4-week follow-up.
Main Results:
- The average headache intensity decreased from 4.7 to 3.1 (on a 10-point scale) during the study.
- 57% of patients achieved complete headache resolution within an average of 7.6 days of medication discontinuation.
- Ibuprofen was the most frequently overused medication (71%).
Conclusions:
- Abruptly stopping offending medications leads to improvement in the majority of pediatric patients with MOH.
- Average pain intensity was reduced by over one point in patients who ceased abortive medication use.
- Further large-scale studies are warranted to confirm the efficacy of medication withdrawal strategies in pediatric MOH.
Objective:
The objective of this study is to document pain scores during withdrawal of abortive medication in patients diagnosed with medication overuse headache.
Design:
Cross-sectional study.
Setting:
Children's National Hospital's Headache Program.
Subjects:
Patients 6-18 years of age who presented to the Headache Clinic at Children's National Hospital with presumed medication overuse headache between March 2017 and March 2019 were invited to participate.
Methods:
Patients were instructed to abruptly discontinue overused medications and record their headache characteristics daily in a diary for 8 weeks.
Results:
Fourteen diaries were returned and analyzed at a 4-week follow-up visit. Ninety-three percent of the patients were females, with a median age of 14.9 years (standard deviation [SD] = 2.0). The average headache intensity upon study entry was 4.7 out of 10 (SD = 2.5), and the average headache intensity upon study completion was 3.1 (SD = 2.5). Of the patients, 57% had daily headaches upon study entry, 71% had improved pain intensity from the first diary entry to the last diary entry, and 57% had complete headache resolution at an average of 7.6 days from medication discontinuation (SD = 5.1). Ibuprofen was the most overused medication (71%).
Conclusions:
Our findings suggest that medication overuse headache will improve in the majority of pediatric patients who abruptly stop the offending medication(s) in an average of 8 days from withdrawal. Average pain intensity was reduced by more than one point among all patients who stopped taking abortive medications. Further larger-scale studies on medication withdrawal in pediatric patients with medication overuse headache could help us better understand whether this management strategy is effective.
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