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

J Headache Pain. 2017 Dec;18(1):56. doi: 10.1186/s10194-017-0763-9. Epub 2017 May 12.


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.

Keywords: Detoxification; Medication overuse headache; Migraine.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Acetaminophen / therapeutic use*
  • Adult
  • Analgesics, Non-Narcotic / therapeutic use*
  • Drug Therapy, Combination
  • Female
  • Glucocorticoids / therapeutic use*
  • Headache Disorders, Secondary / drug therapy*
  • Humans
  • Intention to Treat Analysis
  • Male
  • Methylprednisolone / therapeutic use*
  • Middle Aged
  • Migraine Disorders / drug therapy*
  • Pilot Projects
  • Prescription Drug Overuse*
  • Single-Blind Method
  • Substance Withdrawal Syndrome / drug therapy*
  • Treatment Outcome


  • Analgesics, Non-Narcotic
  • Glucocorticoids
  • Acetaminophen
  • Methylprednisolone