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Treatment of withdrawal headache in patients with medication overuse headache: a pilot study

BACKGROUND: Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. Still debated is the role of the steroid therapy. The aim of this study was to evaluate the effectiveness of methylprednisolone o...

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Autores principales: Cevoli, Sabina, Giannini, Giulia, Favoni, Valentina, Terlizzi, Rossana, Sancisi, Elisa, Nicodemo, Marianna, Zanigni, Stefano, Bacchi Reggiani, Maria Letizia, Pierangeli, Giulia, Cortelli, Pietro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Milan 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429287/
https://www.ncbi.nlm.nih.gov/pubmed/28500492
http://dx.doi.org/10.1186/s10194-017-0763-9
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author Cevoli, Sabina
Giannini, Giulia
Favoni, Valentina
Terlizzi, Rossana
Sancisi, Elisa
Nicodemo, Marianna
Zanigni, Stefano
Bacchi Reggiani, Maria Letizia
Pierangeli, Giulia
Cortelli, Pietro
author_facet Cevoli, Sabina
Giannini, Giulia
Favoni, Valentina
Terlizzi, Rossana
Sancisi, Elisa
Nicodemo, Marianna
Zanigni, Stefano
Bacchi Reggiani, Maria Letizia
Pierangeli, Giulia
Cortelli, Pietro
author_sort Cevoli, Sabina
collection PubMed
description BACKGROUND: Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. Still debated is the role of the steroid therapy. The aim of this study was to evaluate the effectiveness of methylprednisolone or paracetamol in the treatment of withdrawal headache in MOH. METHODS: We performed a pilot, randomized, single-blinded, placebo controlled trial. MOH patients, unresponsive to a 3 months prophylaxis, underwent withdrawal therapy on an inpatient basis. Overused medications were abruptly stopped and methylprednisolone 500 mg i.v (A) or paracetamol 4 g i.v. (B) or placebo i.v. (C) were given daily for 5 days. Patients were monitored at 1 and 3 months. RESULTS: Eighty three consecutive MOH patients were enrolled. Fifty seven patients completed the study protocol. Nineteen patients were randomized to each group. Withdrawal headache on the 5th day was absent in 21.0% of group A, in 31.6% of group B and in 12.5% of group C without significant differences. Withdrawal headache intensity decreased significantly after withdrawal without differences among the groups. Rregardless of withdrawal treatment, 52% MOH patients reverted to an episodic migraine and 62% had no more medication overuse after 3 months. CONCLUSIONS: This study suggests that in a population of severe MOH patients, withdrawal headache decreased significantly in the first 5 days of withdrawal regardless of the treatment used. Methylprednisolone and paracetamol are not superior to placebo at the end of the detoxification program.
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spelling pubmed-54292872017-05-18 Treatment of withdrawal headache in patients with medication overuse headache: a pilot study Cevoli, Sabina Giannini, Giulia Favoni, Valentina Terlizzi, Rossana Sancisi, Elisa Nicodemo, Marianna Zanigni, Stefano Bacchi Reggiani, Maria Letizia Pierangeli, Giulia Cortelli, Pietro J Headache Pain Research Article BACKGROUND: Drug withdrawal still remains the key element in the treatment of Medication Overuse Headache (MOH), but there is no consensus about the withdrawal procedure. Still debated is the role of the steroid therapy. The aim of this study was to evaluate the effectiveness of methylprednisolone or paracetamol in the treatment of withdrawal headache in MOH. METHODS: We performed a pilot, randomized, single-blinded, placebo controlled trial. MOH patients, unresponsive to a 3 months prophylaxis, underwent withdrawal therapy on an inpatient basis. Overused medications were abruptly stopped and methylprednisolone 500 mg i.v (A) or paracetamol 4 g i.v. (B) or placebo i.v. (C) were given daily for 5 days. Patients were monitored at 1 and 3 months. RESULTS: Eighty three consecutive MOH patients were enrolled. Fifty seven patients completed the study protocol. Nineteen patients were randomized to each group. Withdrawal headache on the 5th day was absent in 21.0% of group A, in 31.6% of group B and in 12.5% of group C without significant differences. Withdrawal headache intensity decreased significantly after withdrawal without differences among the groups. Rregardless of withdrawal treatment, 52% MOH patients reverted to an episodic migraine and 62% had no more medication overuse after 3 months. CONCLUSIONS: This study suggests that in a population of severe MOH patients, withdrawal headache decreased significantly in the first 5 days of withdrawal regardless of the treatment used. Methylprednisolone and paracetamol are not superior to placebo at the end of the detoxification program. Springer Milan 2017-05-12 /pmc/articles/PMC5429287/ /pubmed/28500492 http://dx.doi.org/10.1186/s10194-017-0763-9 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Research Article
Cevoli, Sabina
Giannini, Giulia
Favoni, Valentina
Terlizzi, Rossana
Sancisi, Elisa
Nicodemo, Marianna
Zanigni, Stefano
Bacchi Reggiani, Maria Letizia
Pierangeli, Giulia
Cortelli, Pietro
Treatment of withdrawal headache in patients with medication overuse headache: a pilot study
title Treatment of withdrawal headache in patients with medication overuse headache: a pilot study
title_full Treatment of withdrawal headache in patients with medication overuse headache: a pilot study
title_fullStr Treatment of withdrawal headache in patients with medication overuse headache: a pilot study
title_full_unstemmed Treatment of withdrawal headache in patients with medication overuse headache: a pilot study
title_short Treatment of withdrawal headache in patients with medication overuse headache: a pilot study
title_sort treatment of withdrawal headache in patients with medication overuse headache: a pilot study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429287/
https://www.ncbi.nlm.nih.gov/pubmed/28500492
http://dx.doi.org/10.1186/s10194-017-0763-9
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