Advice alone versus structured detoxification programmes for complicated medication overuse headache (MOH): a prospective, randomized, open-label trial

J Headache Pain. 2013 Feb 8;14(1):10. doi: 10.1186/1129-2377-14-10.


Background: The aim of this study was to compare the effectiveness of an educational strategy (advice to withdraw the overused medication/s) with that of two structured pharmacological detoxification programmes in patients with complicated medication overuse headache (MOH) plus migraine.

Methods: One hundred and thirty-seven complicated MOH patients participated in the study. MOH was defined as complicated in patients presenting at least one of the following: a) a diagnosis of co-existent and complicating medical illnesses; b) a current diagnosis of mood disorder, anxiety disorder, eating disorder, or substance addiction disorder; c) relapse after previous detoxification treatment; d) social and environmental problems; e) daily use of multiple doses of symptomatic medications. Group A (46 patients) received only intensive advice to withdraw the overused medication/s. Group B (46 patients) underwent a standard detoxification programme as outpatients (advice+steroids+preventive treatment). Group C (45 patients) underwent a standard inpatient withdrawal programme (advice+steroids+fluid replacement and antiemetics preventive treatment). Withdrawal therapy was considered successful if, after two months, the patient had reverted to an intake of NSAIDs lower than 15 days/month or to an intake of other symptomatic medication/s lower than 10 days/month.

Results: Twenty-two patients failed to attend follow-up visits (11 in Group A, 9 in Group B, 2 in Group C, p<0.03). Overall, we detoxified 70% of the whole cohort, 60.1% of the patients in Group A and in Group B, and 88.8% of those in Group C (p<0.01).

Conclusions: Inpatient withdrawal is significantly more effective than advice alone or an outpatient strategy in complicated MOH patients.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Headache Disorders, Secondary / chemically induced*
  • Headache Disorders, Secondary / therapy*
  • Humans
  • Inpatients
  • Male
  • Middle Aged
  • Outpatients
  • Substance Withdrawal Syndrome / drug therapy*
  • Substance-Related Disorders / therapy*
  • Treatment Outcome