EPIGAME a vignette-based study of management practices of medication overuse in migraine, among French neurologists

Medication overuse headache (MOH) is a common and disabling condition associated with the excessive use of acute headache treatments. This study aimed to investigate MOH management by neurologists in France.

A vignette-based study was conducted among 107 neurologists (60 from private practice, 47 from hospitals or both hospital and private practice) in France. Participants evaluated four randomized clinical vignettes simulating real-life MOH cases and selected from five treatment strategies: (1) drug withdrawal and immediate initiation of preventive treatment, (2) initiation of preventive treatment without drug withdrawal, (3) initiation of preventive treatment with titration followed by drug withdrawal, (4) drug withdrawal alone, and (5) referral to a specialized centre.

The most common strategies of MOH management involved combining drug withdrawal with preventive treatment: 44.1% of cases received preventive treatment with titration followed by drug withdrawal, and 42.5% received immediate preventive treatment alongside drug withdrawal. Most neurologists (82.6%) recommended outpatient care, while hospital-based neurologists were more likely to suggest inpatient treatment. A progressive drug withdrawal protocol was preferred by 73.4%, with the goal of limiting drug use to fewer than 8 days per month in 81.3% of cases. Preventive treatments were most commonly antidepressants (52.2%), followed by beta-blockers (24.4%) and antiepileptics (14.9%). Educational advice, non-pharmacological treatments, and psychological care were frequently recommended as complementary approaches. No significant associations were found between clinical parameters (e.g., drug type, comorbidities) and treatment choices.

This study with an innovative approach provides valuable insight into the current management practices for MOH among neurologists in France, revealing alignment with established guidelines outlined by "La Société française d'études des migraines et céphalées (SFEMC)" guidelines, being withdrawal coupled with preventative treatment.