Corticosteroids in withdrawal therapy following medication-overuse headache: a systematic review

Medication-overuse headache (MOH) affects 1-2% of the population and imposes substantial burden. Corticosteroids are often used as bridge therapy during withdrawal, although their effectiveness remains uncertain. This study aims to evaluate the effectiveness of corticosteroids as a withdrawal strategy in MOH.

A systematic review with meta-analysis was conducted in accordance with PRISMA guidelines. The protocol was registered in PROSPERO (ID: 1161824). Searches were performed in PubMed, MEDLINE, EMBASE, the Cochrane Library, Web of Science, SciELO, and LILACS through June 2025. Randomized, placebo-controlled trials assessing corticosteroids during withdrawal therapy in adults with MOH were included. Random-effects meta-analyses were performed when feasible using RevMan 7.2.0.

Of 4,483 records identified, four trials comprising 250 participants met eligibility criteria. Two studies presented high risk of bias, two raised some concerns. Considerable heterogeneity in design, dosing regimens, follow-up duration, and outcome definitions limited comparability and precluded a unified pooled analysis. Across studies, results consistently failed to show benefit. Meta-analytic findings demonstrated no advantage of corticosteroids over placebo regarding early withdrawal headache, withdrawal symptoms or reversal of medication overuse.

The available evidence does not support corticosteroids as effective withdrawal therapy for MOH.