title: Detoxification of medication-overuse headache by a multidisciplinary treatment programme is highly effective: a comparison of two consecutive treatment methods in an open-label design.
abstract: BACKGROUND
  Evidence for optimal medication-overuse headache treatment is lacking. Some experts suggest reduced symptomatic medication with prophylactics from the start of withdrawal, while others suggest a two-month drug-free period with multidisciplinary education.
  
  
  OBJECTIVE
  To examine the acceptability, feasibility and outcome of these two regimes in a non-randomised open-label study.
  
  
  METHODS
  Patients able to undergo outpatient detoxification, with medication-overuse headache that had previously been unsuccessfully treated by specialists and without significant co-morbidities were treated with (A) individual withdrawal with restricted symptomatic medication and prophylactics from Day 1 or (B) a two-month drug-free period and multidisciplinary education in groups. All patients received close one-year follow-up.
  
  
  RESULTS
  Eighty-six of 98 patients completed follow-up. Both treatments proved highly effective-80.0% of Group A and 85.4% of Group B were cured of medication-overuse headache. Headache-frequency reduction was 40.2% in Group A and 38.4% in group B. In 48.9% of group A and 48.8% of group B, headache-frequency reduction was >50%. Programme B required fewer resources from the staff and only 61.9% of these patients needed prophylactics after two months compared with 84.8% in programme A.
  
  
  CONCLUSIONS
  Both structured detoxification programmes proved highly effective with one-year close follow-up in previously treatment-resistant patients with medication-overuse headache. We suggest multidisciplinary education for patients in groups and delaying initiation of prophylactics until after the detoxification.
authors: Danish Headache Centre, University of Copenhagen, Glostrup Hospital, Denmark.
authors: Signe B
authors: SB
authors: Munksgaard
authors: Lars
authors: L
authors: Bendtsen
authors: Rigmor H
authors: RH
authors: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D051271:Headache Disorders, Secondary / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D059408:Pain Management; D010348:Patient Care Team; D015995:Prevalence; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000700:Analgesics