title: Treatment of medication overuse headache--guideline of the EFNS headache panel.
abstract: BACKGROUND
  Medication overuse headache is a common condition with a population-based prevalence of more than 1-2%. Treatment is based on education, withdrawal treatment (detoxification), and prophylactic treatment. It also includes management of withdrawal headache.
  
  
  OBJECTIVE
  This guideline aims to give treatment recommendations for this headache.
  
  
  METHODS
  Evaluation of the scientific literature.
  
  
  RESULTS
  Abrupt withdrawal or tapering down of overused medication is recommended, the type of withdrawal therapy is probably not relevant for the outcome of the patient. However, inpatient withdrawal therapy is recommended for patients overusing opioids, benzodiazepine, or barbiturates. It is further recommended to start individualized prophylactic drug treatment at the first day of withdrawal therapy or even before. The only drug with moderate evidence for the prophylactic treatment in patients with chronic migraine and medication overuse is topiramate up to 200mg. Corticosteroids (at least 60mg prednisone or prednisolone) and amitriptyline (up to 50mg) are possibly effective in the treatment of withdrawal symptoms. Patients after withdrawal therapy should be followed up regularly to prevent relapse of medication overuse.
  
  
  CONCLUSIONS
  Medication overuse headache can be treated according to evidence-based recommendations.
authors.affiliation: Department of Neurology, University of Münster, Münster, Germany. everss@uni-muenster.de
authors.forename: S
authors.initials: S
authors.lastname: Evers
authors.forename: R
authors.initials: R
authors.lastname: Jensen
mesh_terms: D000700:Analgesics / Q000009:adverse effects; D051271:Headache Disorders, Secondary / Q000139:chemically induced / Q000628:therapy*; D006801:Humans
chemical_list: D000700:Analgesics