title: Advice alone versus structured detoxification programmes for complicated medication overuse headache (MOH): a prospective, randomized, open-label trial.
abstract: BACKGROUND
  The aim of this study was to compare the effectiveness of an educational strategy (advice to withdraw the overused medication/s) with that of two structured pharmacological detoxification programmes in patients with complicated medication overuse headache (MOH) plus migraine.
  
  
  METHODS
  One hundred and thirty-seven complicated MOH patients participated in the study. MOH was defined as complicated in patients presenting at least one of the following: a) a diagnosis of co-existent and complicating medical illnesses; b) a current diagnosis of mood disorder, anxiety disorder, eating disorder, or substance addiction disorder; c) relapse after previous detoxification treatment; d) social and environmental problems; e) daily use of multiple doses of symptomatic medications. Group A (46 patients) received only intensive advice to withdraw the overused medication/s. Group B (46 patients) underwent a standard detoxification programme as outpatients (advice+steroids+preventive treatment). Group C (45 patients) underwent a standard inpatient withdrawal programme (advice+steroids+fluid replacement and antiemetics preventive treatment). Withdrawal therapy was considered successful if, after two months, the patient had reverted to an intake of NSAIDs lower than 15 days/month or to an intake of other symptomatic medication/s lower than 10 days/month.
  
  
  RESULTS
  Twenty-two patients failed to attend follow-up visits (11 in Group A, 9 in Group B, 2 in Group C, p<0.03). Overall, we detoxified 70% of the whole cohort, 60.1% of the patients in Group A and in Group B, and 88.8% of those in Group C (p<0.01).
  
  
  CONCLUSIONS
  Inpatient withdrawal is significantly more effective than advice alone or an outpatient strategy in complicated MOH patients.
authors.affiliation: Headache Clinic, INI Grottaferrata, Via S,Anna s,n,c, 00046, Grottaferrata, Rome, Italy. paolo.rossi90@alice.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Rossi
authors.forename: Jessica Veronica
authors.initials: JV
authors.lastname: Faroni
authors.forename: Cristina
authors.initials: C
authors.lastname: Tassorelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nappi
mesh_terms: D000328:Adult; D005260:Female; D051271:Headache Disorders, Secondary / Q000139:chemically induced* / Q000628:therapy*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy*; D019966:Substance-Related Disorders / Q000628:therapy*; D016896:Treatment Outcome
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