title: Detoxification for medication overuse headache is not necessary.
abstract: BACKGROUND
  Current textbook knowledge states that patients with chronic migraine and medication overuse should be withdrawn from acute medication before initiating preventive drug therapy.
  
  
  BACKGROUND
  This recommendation is based on the clinical impression that patients with chronic migraine and medication overuse are refractory to preventive therapy. Recently, however, four randomised trials, two with topiramate and two with onabotulinum toxin A, showed that about half of patients with chronic migraine and medication overuse will respond to these treatments and show both a reduction in migraine days and intake of acute medication.
  
  
  CONCLUSIONS
  Therefore, we propose to educate patients on the mechanisms of medication overuse and motivate them to reduce intake frequency. Patients who fail should be offered either topiramate or onabotulinum toxin A in combination with behavioural therapy and regular exercise. If this approach fails, patients should be offered withdrawal therapy.
authors: University Hospital Essen, Germany. h.diener@uni-essen.de
authors: Hans-Christoph
authors: HC
authors: Diener
mesh_terms: D000700:Analgesics / Q000009:adverse effects* / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006261:Headache / Q000139:chemically induced* / Q000517:prevention & control*; D006801:Humans; D016896:Treatment Outcome
chemical_list: D000700:Analgesics