Journal
CEPHALALGIA
Volume 31, Issue 11, Pages 1189-1198Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/0333102411412088
Keywords
Chronic daily headache; migraine; in-patient withdrawal; out-patient withdrawal; medication overuse headache; dependency
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Funding
- Fondation de France
- Fondation CNP
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Background: Medication-overuse headache (MOH) management usually includes a medication withdrawal. The choice of withdrawal modalities remains a matter of debate. Methods: We compared the efficacy of in-patient versus out-patient withdrawal programmes in 82 consecutive patients with MOH in an open-label prospective randomized trial. The main outcome measure was the reduction in number of headache days after 2 months and after 2 years. The responders were defined as patients who had reverted to episodic headaches and to an intake of acute treatments for headache less than 10 days per month. Results: Seventy-one patients had a complete drug withdrawal (n = 36 in the out-patient group; n = 35 in the in-patient group). The reduction of headache frequency and subjective improvement did not differ between groups. The long-term responder rate was similar in the out-and in-patient groups (44% and 44%; p = 0.810). The only predictive factor of a bad outcome 2 years after withdrawal was an initial consumption of more than 150 units of acute treatments for headache per month (OR 3.1; 95% confidence interval 1.1-9.3; p = 0.044). Conclusion: Given that we did not observe any difference in efficacy between the in-and out-patient withdrawals, we would recommend out-patient withdrawal in the first instance for patients with uncomplicated MOH.
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