title: In-patient versus out-patient withdrawal programmes for medication overuse headache: a 2-year randomized trial.
abstract: BACKGROUND
  Medication-overuse headache (MOH) management usually includes a medication withdrawal. The choice of withdrawal modalities remains a matter of debate.
  
  
  METHODS
  We compared the efficacy of in-patient versus out-patient withdrawal programmes in 82 consecutive patients with MOH in an open-label prospective randomized trial. The main outcome measure was the reduction in number of headache days after 2 months and after 2 years. The responders were defined as patients who had reverted to episodic headaches and to an intake of acute treatments for headache less than 10 days per month.
  
  
  RESULTS
  Seventy-one patients had a complete drug withdrawal (n = 36 in the out-patient group; n = 35 in the in-patient group). The reduction of headache frequency and subjective improvement did not differ between groups. The long-term responder rate was similar in the out- and in- patient groups (44% and 44%; p = 0.810). The only predictive factor of a bad outcome 2 years after withdrawal was an initial consumption of more than 150 units of acute treatments for headache per month (OR = 3.1; 95% confidence interval 1.1-9.3; p = 0.044).
  
  
  CONCLUSIONS
  Given that we did not observe any difference in efficacy between the in- and out-patient withdrawals, we would recommend out-patient withdrawal in the first instance for patients with uncomplicated MOH.
authors.affiliation: North University Hospital, France. christelle.creach@univ-st-etienne.fr
authors.forename: C
authors.initials: C
authors.lastname: Créac'h
authors.forename: P
authors.initials: P
authors.lastname: Frappe
authors.forename: M
authors.initials: M
authors.lastname: Cancade
authors.forename: B
authors.initials: B
authors.lastname: Laurent
authors.forename: R
authors.initials: R
authors.lastname: Peyron
authors.forename: G
authors.initials: G
authors.lastname: Demarquay
authors.forename: M
authors.initials: M
authors.lastname: Navez
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects; D005260:Female; D020773:Headache Disorders / Q000139:chemically induced* / Q000534:rehabilitation*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012046:Rehabilitation / Q000379:methods*; D013375:Substance Withdrawal Syndrome / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000700:Analgesics