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Management of medication overuse headache

Domenico D'Amico1, Licia Grazzi1, Stewart J Tepper2

  • 1UOC Neuroalgologia, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.

Handbook of Clinical Neurology
|February 2, 2024
PubMed

Insights

Medication overuse headache (MOH) is a chronic condition caused by frequent use of acute migraine medications. Treatment involves withdrawal, prevention, and multidisciplinary approaches, with new therapies offering alternatives.

Area of Science:

  • Neurology
  • Headache Medicine

Background:

  • Medication overuse headache (MOH) transforms episodic migraines into chronic daily headaches.
  • MOH poses a significant burden on patients and society due to its prevalence and complexity.
  • Patients with MOH often present with comorbidities, complicating treatment strategies.

Approach:

  • Review of current treatment strategies for MOH.
  • Evaluation of educational, withdrawal, and prophylactic interventions.
  • Assessment of multidisciplinary therapies including behavioral and neuromodulation options.

Key Points:

  • Treatment requires patient education, medication withdrawal, and preventative strategies.
  • Multidisciplinary approaches are crucial for managing complex MOH cases.
  • Anti-CGRP monoclonal antibodies present a novel therapeutic option for select patients.

Conclusions:

  • Integrated care programs are essential for effective MOH management.
  • Guidance is provided for selecting patients who will benefit from coordinated programs.
  • Future research should focus on optimizing treatment pathways for MOH.
Keywords:
Anti-CGRP monoclonal antibodiesBehavioral therapiesChronic migraineManagementMedication overuse headacheNeuromodulationPharmacologic prophylaxisPreventionTreatmentWithdrawal programs

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