Patterns of Formation and Evaluation of the Efficiency of Medical Overuse Headache Therapy

Study Objective: The aim of the study was to evaluate the patterns of medical overuse headache (MOH), the effectiveness of therapy, and to compare 2 subgroups of patients with chronic migraine, medical overuse of symptomatic analgesics: with MOH and without MOH.

Study Design: prospective cohort study.

Materials and Methods. The study included 20 patients aged 18 to 75 years with an established diagnosis of chronic migraine medical overuse of symptomatic analgesics. We’re planning to apply a headache diary, several scales about various characteristics of headaches, the psychological state of patients, scales on lifestyle and quality of life, somatic pathology.

Study Results. All patients were recommended to cancel the “guilty” analgesic and limit the use of the drug with analgesic action from another group. For prophylaxis, metoprolol was used in 6 (30%) cases, topiramate — in 2 (10%) cases, amitriptyline — in 30%, venlafaxine in 30%. After 3 months from the start of therapy, patients noted the greatest reduction in the frequency and intensity of headache when taking amitriptyline at a dose of up to 50 mg, venlafaxine at a dose of up to 150 mg. At the time of withdrawal, “rebound” symptoms and withdrawal syndrome developed in 14 (70%) people. Detoxification therapy (dexamethasone 4–8 mg per 200 ml of saline and magnesia 10% 25 ml N10) was carried out in 12 (60%) patients. Over 3 months of follow-up, the occurrence of a headache attack decreased by 2 points on the intensity scale, duration — by an average of 6 hours, the number of days with a headache increased by an average of 3.4 days, the number of days with the use of pathogens per month — by 12.6 days.

Conclusion. It is necessary to raise the awareness of therapists, neurologists about the causes, patterns, methods of treatment of МОН, as well as about the risk factors for its recurrence. Patient compliance can be improved by telephone interviews, face-to-face consultations 1–3 months after the start of preventive therapy. With the correct use of the prophylactic drug and following the recommendations to limit the overuse of symptomatic analgesics, after 3 months the patient's quality of life improves, the headache decreases in frequency and intensity, and cognitive functions improve.

1. Galli F., Tanzilli A., Simonelli A., Tassorelli C. et al. Personality and personality disorders in medication-overuse headache: a controlled study by SWAP-200. Pain Res. Manag. 2019; 2019: 1874078. DOI: 10.1155/2019/1874078

2. Diener H.C., Holle D., Dresler T., Gaul C. Chronic headache due to overuse of analgesics and anti-migraine agents. Dtsch Arztebl. Int. 2018; 115(22): 365–70. DOI: 10.3238/arztebl.2018.0365

3. Diener H.C., Dodick D., Evers S., Holle D. et al. Pathophysiology, prevention, and treatment of medication overuse headache. Lancet Neurol. 2019; 18(9): 891–902. DOI: 10.1016/S1474-4422(19)30146-2

4. Saper J.R., Da Silva A.N. Medication overuse headache: history, features, prevention and management strategies. CNS Drugs. 2013; 27(11): 867–77. DOI: 10.1007/s40263-013-0081-y

5. Tabeeva G.R., Osipova V.V., Filatova E.G., Azimova Yu.E. et al. Evaluation and treatment of medication-overuse headache: Russian experts’ guidelines. Neurology, Neuropsychiatry, Psychosomatics. 2022; 14(1): 4–13. (in Russian). DOI: 10.14412/2074-2711-2022-1-4-13

6. Chen P.-K., Wang S.-J. Medication overuse and medication overuse headache: risk factors, comorbidities, associated burdens and nonpharmacologic and pharmacologic treatment approaches. Curr. Pain Headache Rep. 2019; 23(8): 60. DOI: 10.1007/s11916-019-0796-7

7. Katsarava Z., Fritsche G., Muessig M., Diener H.C. et al. Clinical features of withdrawal headache following overuse of triptans and other headache drugs. Neurology. 2001; 57(9): 1694–8. DOI: 10.1212/wnl.57.9.1694

8. Katsarava Z., Diener H.C., Limmroth V. Medication overuse headache. focus on analgesics, ergot alkaloids and triptans. Drug Saf. 2001; 24(12): 921–7. DOI: 10.2165/00002018-200124120-00005

9. Radat F., Creac'h C., Guegan-Massardier E., Mick G. et al. Behavioral dependence in patients with medication overuse headache: a cross-sectional study in consulting patients using the DSM-IV criteria. Headache. 2008; 48(7): 1026–36. DOI: 10.1111/j.1526-4610.2007.00999.x

10. Nielsen M., Carlsen L.N., Munksgaard S.B., Engelstoft I.M.S. et al. Complete withdrawal is the most effective approach to reduce disability in patients with medication-overuse headache: a randomized controlled open-label trial. Cephalalgia. 2019; 39(7): 863–72. DOI: 10.1177/0333102419828994

11. Carlsen L.N., Munksgaard S.B., Nielsen M., Engelstoft I.M.S. et al. Comparison of 3 treatment strategies for medication overuse headache: a randomized clinical trial. JAMA Neurol. 2020; 77(9): 1069–78. DOI: 10.1001/jamaneurol.2020.1179

12. Grazzi L., Grignani E., D’Amico D., Sansone E. et al. Is Medication overuse drug specific or not? Data from a review of published literature and from an original study on Italian MOH patients. Curr. Pain Headache Rep. 2018; 22(11): 71. DOI: 10.1007/s11916-018-0729-x