- Three treatment strategies similarly reduced headache days in patients with medication overuse headache, but combined withdrawal and preventive treatment netted the highest cure rate.
Why this matters
- Medication overuse headache is prevalent, costly, and disabling.
- At 6 months, reduction in headache days per month (95% CIs) did not differ by treatment strategy (P=.20):
- 12.3 (9.3-15.3) with withdrawal plus prevention.
- 9.9 (7.2-12.6) with prevention.
- 8.5 (5.6-11.5) with withdrawal plus optional prevention.
- Rate of reversion to episodic headache (P=.03):
- 74.2% with withdrawal plus prevention.
- 60.0% with prevention.
- 41.7% with withdrawal plus optional prevention.
- Rate of cure (P=.03):
- 96.8% with withdrawal plus prevention.
- 74.3% with prevention alone.
- 88.9% with withdrawal plus optional prevention.
- Likelihood of cure was 30% higher with withdrawal plus prevention vs prevention (relative risk, 1.3; 95% CI, 1.1-1.6).
- Danish population-based randomized controlled trial (DEFINE3 trial).
- 120 patients with medication overuse headache (migraine and/or tension-type headache).
- Withdrawal plus preventive treatment from start.
- Preventive treatment only.
- Withdrawal plus optional delayed preventive treatment.
- Main outcome: change in headache days per month.
- Funding: TrygFonden.
- Majority of patients overused only simple analgesics.
- Inability to achieve blinding.
- Patients with complexity were excluded.