title: A consensus protocol for the management of medication-overuse headache: Evaluation in a multicentric, multinational study.
abstract: BACKGROUND
  The management of medication-overuse headache (MOH) is often difficult and no specific guidelines are available as regards the most practical and effective approaches. In this study we defined and tested a consensus protocol for the management of MOH on a large population of patients distributed in different countries.
  
  
  METHODS
  The protocol was based on evidence from the literature and on consolidated expertise of the members of the consensus group. The study was conducted according to a multicentric interventional design with the enrolment of 376 MOH subjects in four centres from Europe and two centres in Latin America. The majority of patients were treated according to an outpatient detoxification programme. The post-detoxification follow-up lasted six months.
  
  
  RESULTS
  At the final evaluation, two-thirds of the subjects were no longer overusers and in 46.5% of subjects headache had reverted back to an episodic pattern of headache. When comparing the subjects who underwent out-patient detoxification vs those treated with in-patient detoxification, both regimens proved effective, although the drop-out rate was higher in the out-patient approach.
  
  
  CONCLUSIONS
  The present findings support the effectiveness and usability of the proposed consensus protocol in different countries with different health care modalities.
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Pavia Dept. of Brain and Behaviour, University of Pavia, Italy cristina.tassorelli@mondino.it.
authors.forename: C
authors.initials: C
authors.lastname: Tassorelli
authors.affiliation: Danish Headache Centre, Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Denmark.
authors.forename: R
authors.initials: R
authors.lastname: Jensen
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Pavia.
authors.forename: M
authors.initials: M
authors.lastname: Allena
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Pavia Dept. of Brain and Behaviour, University of Pavia, Italy.
authors.forename: R
authors.initials: R
authors.lastname: De Icco
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Pavia.
authors.forename: G
authors.initials: G
authors.lastname: Sances
authors.affiliation: Department of Neurology, University of Essen, Germany.
authors.forename: Z
authors.initials: Z
authors.lastname: Katsarava
authors.affiliation: Foundation of the Valencian Community, University Clinical Hospital, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Lainez
authors.affiliation: Foundation for Combating Neurological Diseases of Childhood, Argentina.
authors.forename: Ja
authors.initials: J
authors.lastname: Leston
authors.affiliation: Department of Neurology, Pontificia Catolica University of Chile, Chile.
authors.forename: R
authors.initials: R
authors.lastname: Fadic
authors.affiliation: ISalud University, Argentina.
authors.forename: S
authors.initials: S
authors.lastname: Spadafora
authors.affiliation: Bioengeneering and Medical Informatics Consortium (CBIM), Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pagani
authors.affiliation: Headache Science Center, C. Mondino National Neurological Institute, Pavia.
authors.forename: G
authors.initials: G
authors.lastname: Nappi
keywords: Medication-overuse headache; analgesics; chronic headache; consensus protocol; detoxification; migraine