European Academy of Neurology guideline on the management of medication-overuse headache

H C Diener; F Antonaci; M Braschinsky; S Evers; R Jensen; M Lainez; E S Kristoffersen; C Tassorelli; K Ryliskiene; J A Petersen

doi:10.1111/ene.14268

European Academy of Neurology guideline on the management of medication-overuse headache

Eur J Neurol. 2020 Jul;27(7):1102-1116. doi: 10.1111/ene.14268. Epub 2020 May 19.

Authors

H C Diener¹, F Antonaci^{2

3}, M Braschinsky⁴, S Evers^{5

6}, R Jensen⁷, M Lainez^{8

9}, E S Kristoffersen^{10

11}, C Tassorelli^{2

3}, K Ryliskiene¹², J A Petersen¹³

Affiliations

¹ Institute for Medical Informatics, Biometry and Epidemiology, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
² IRCCS C. Mondino Foundation, Pavia, Italy.
³ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
⁴ Headache Clinic, Neurology Clinic, Tartu University Hospital, Tartu, Estonia.
⁵ Faculty of Medicine, University of Münster, Münster, Germany.
⁶ Krankenhaus Lindenbrunn, Coppenbrügge, Germany.
⁷ Danish Headache Center, Neurological Clinic, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
⁸ Department of Neurology, Hospital Clínico Universitario, Valencia, Spain.
⁹ Department of Neurology, Universidad Católica de Valencia, Valencia, Spain.
¹⁰ Department of Neurology, Akershus University Hospital, Oslo, Norway.
¹¹ Department of General Practice, University of Oslo, Oslo, Norway.
¹² Department of Neurology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
¹³ Department Of Neurology, University Hospital Zurich, Zurich, Switzerland.

PMID: 32430926
DOI: 10.1111/ene.14268

Abstract

Background: The frequent use of medication to treat migraine attacks can lead to an increase in migraine frequency and is called medication-overuse headache (MOH).

Methods: Based on the available literature in this guideline, the first step in patient management is education and counselling.

Results: Patients with MOH should be managed by a multidisciplinary team of neurologists or pain specialists and behavioral psychologists. Patients in whom education is not effective should be withdrawn from overused drugs and should receive preventive treatment with drugs of proven efficacy. Patients with MOH in whom preventive treatment is not effective should undergo drug withdrawal. Drug intake can be abruptly terminated or restricted in patients overusing simple analgesics, ergots or triptan medication. In patients with long-lasting abuse of opioids, barbiturates or tranquilizers, slow tapering of these drugs is recommended. Withdrawal can be performed on an outpatient basis or in a daycare or inpatient setting.

Keywords: chronic migraine; medication; medication overuse; medication-overuse headache; migraine; prevention; primary headache; tension-type headache; therapy; treatment.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Analgesics / adverse effects
Headache
Headache Disorders, Secondary* / drug therapy
Humans
Neurology*
Tryptamines

Substances

Analgesics
Tryptamines