Consensus treatment of medication overuse headache in Latin America and Europe

摘要

Medication overuse headache (MOH) is preventable and treatable. However, MOH is a major contributor to headache-related disability, affecting up to 70% of patients in headache specialty practices (1). The management of MOH is complicated as patients often have difficulty stopping the overused medication and relapse rates following successful detoxification are high, consistent with the concept of MOH as a bio-behavioral disorder, with a shared neurobiology to addiction (2). Analgesics appear to carry varying risks for MOH among susceptible patients, with the strongest associations reported for opioid- and butalbital-containing analgesics (3,4). Non-steroidal anti-inflammatory drugs (NSAIDs) carry the lowest risk, and may even be protective in the development of chronic daily headache for patients with fewer than 10 headache days per month (5). Currently, there is no consensus regarding the optimal approach to management of MOH, with available evidence supporting advice alone (6), detoxification alone (6-9), detoxification with continuation or introduction of prophylactic treatment (6,8,9), and initiation of prophylactic treatment alone without detoxification (7,10,11). Although independent evidence exists for multiple approaches, the current data seem to support a combination of approaches as the most efficacious strategy (7-9). Further, there is no consensus as to whether outpatient or inpatient management is most appropriate, and only limited data on the value of cognitive-behavioral interventions for optimizing rates of successful detoxification and limiting recurrence (12).