Treatment-resistant medication overuse headache can be cured.
OBJECTIVE
To evaluate the long-term efficacy of a structured, multidisciplinary treatment program in patients who had been treated unsuccessfully for medication overuse headache by specialists in an open-label design.


BACKGROUND
Medication overuse headache is a common and disabling disease. Management is complicated by substantial treatment failure and relapse, and those who relapse and nonresponders to treatment are often excluded from studies on medication overuse headache.


METHODS
Patients with medication overuse headache who had previously been unsuccessfully treated by specialists and referred to a specialized, tertiary headache centre were recruited. They underwent a structured 2-month detoxification program and were subsequently closely followed up for 10 months by a multidisciplinary team of physicians, nurses, physiotherapists, and psychologists.


RESULTS
Eighty-six of 98 patients completed the study.


METHODS
At 12-month follow-up, headache frequency was reduced by 39.3% (P < .001), 71 patients (82.6%) remained cured of medication overuse, reduction in headache frequency of more than 50% occurred in 42 patients (48.8%), and 52 (60.5%) reverted to episodic headache. Both of these figures had increased significantly from month 2 to month 12 (P < .001). Medication use was reduced by 62.8% (P < .001).


CONCLUSIONS
Patients with medication overuse headache previously regarded treatment-resistant benefit considerably from multidisciplinary treatment in a structured detoxification program with close follow-up.
Danish Headache Centre, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Nordre Ringvej 57, Glostrup, Denmark.
Signe B
SB
Munksgaard
Lars
L
Bendtsen
Rigmor H
RH
Jensen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects* / Q000493:pharmacokinetics* / Q000627:therapeutic use; D019033:Delivery of Health Care, Integrated; D004351:Drug Resistance; D005260:Female; D005500:Follow-Up Studies; D051271:Headache Disorders, Secondary / Q000139:chemically induced* / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008658:Inactivation, Metabolic; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009726:Nurses; D059825:Physical Therapists; D010820:Physicians; D011584:Psychology; D016896:Treatment Outcome; D055815:Young Adult
D000700:Analgesics