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Medication-overuse headache: Bridging therapies for detoxification
Benjamin R Wakerley1, Prut Koonalintip2
1Department of Neurology, University Hospital Birmingham, United Kingdom; Metabolic Neurology, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, The Medical School, The University of Birmingham, United Kingdom.
Clinical Neurology and Neurosurgery
|November 2, 2025
Summary
Medication-overuse headache (MOH) treatment involves withdrawing the overused acute medication, which significantly reduces headache days. Bridging therapies help manage withdrawal symptoms for successful detoxification.
Area of Science:
- Neurology
- Pharmacology
Background:
- Medication-overuse headache (MOH), or rebound headache, complicates chronic migraine due to frequent acute pain medication use.
- The underlying causes of MOH involve a complex interplay of psychosocial factors, medication class, and genetic predispositions in pain pathways.
Purpose of the Study:
- To review the medication withdrawal process for different acute medication classes in MOH.
- To examine various pharmacological and non-pharmacological bridging therapies used to support MOH detoxification.
Main Methods:
- This narrative review synthesizes existing literature on MOH treatment strategies.
- Focuses on medication withdrawal protocols and adjunctive therapies.
Main Results:
- Acute medication withdrawal is the primary treatment for MOH, leading to reduced monthly headache days at 8 weeks.
- Withdrawal can exacerbate headaches and cause psychological/physical symptoms, necessitating supportive therapies.
Conclusions:
- Successful MOH management relies on effective medication withdrawal and supportive bridging therapies.
- Further research into optimizing bridging strategies for different medication classes is warranted.
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