title: Advice alone vs. structured detoxification programmes for medication overuse headache: a prospective, randomized, open-label trial in transformed migraine patients with low medical needs.
abstract: The aim of this study was to compare the effectiveness of strong advice to withdraw the overused medication with the effectiveness of two structured pharmacological detoxification strategies in a cohort of patients diagnosed with probable migraine overuse headache (MOH) plus migraine and presenting low medical needs. One hundred and twenty patients participated in the study. Exclusion criteria included: previous detoxification treatments, coexistent medical or psychiatric illnesses and overuse of agents containing opioids, benzodiazepines and barbiturates. Group A received only intensive advice to withdraw the overused medication. Group B underwent a standard out-patient detoxification programme (advice+prednisone+preventive treatment). Group C underwent a standard in-patient withdrawal programme (as in group B + fluid replacement and antiemetics). Withdrawal therapy was considered successful if, after 2 months, the patient had reverted to an episodic pattern of headache and to an intake of symptomatic medication on fewer than 10 days/month. We were able to detoxify 75.4% of the whole cohort, 77.5% of patients in group A, 71.7% of patients in group B and 76.9% of those in group C (P>0.05). In patients with migraine plus MOH and low medical needs, effective drug withdrawal may be obtained through the imparting of advice alone.
authors.affiliation: Headache Clinic, INI Grottaferrata, Grottaferrata, Italy. paolo.rossi90@alice.it
authors.forename: P
authors.initials: P
authors.lastname: Rossi
authors.forename: C
authors.initials: C
authors.lastname: Di Lorenzo
authors.forename: J
authors.initials: J
authors.lastname: Faroni
authors.forename: F
authors.initials: F
authors.lastname: Cesarino
authors.forename: G
authors.initials: G
authors.lastname: Nappi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects*; D037001:Directive Counseling / Q000706:statistics & numerical data*; D005260:Female; D051271:Headache Disorders, Secondary / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy* / Q000453:epidemiology; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D000700:Analgesics