Lasting improvement of medication-overuse headache after brief intervention - a long-term follow-up in primary care

Eur J Neurol. 2017 Jul;24(7):883-891. doi: 10.1111/ene.13318. Epub 2017 May 23.


Background and purpose: Withdrawal therapy improves the headache situation for many patients with medication-overuse headache (MOH), but relapses are common. The objective was to assess the long-term effectiveness of a general practitioner conducted brief intervention (BI) for MOH.

Methods: Sixty MOH patients initially participating in a blinded cluster-randomized controlled trial evaluating BI versus business as usual (BAU) were followed up for 16 months. Follow-up was open after 6 months. Headache and medication days per month were evaluated in three groups: BI early (BI throughout the study, n = 24), BI late (initial BAU, then cross-over to BI, n = 22) and BAU throughout the study (n = 14).

Results: Fifty-five of 60 initially included patients completed the follow-up. The mean change over 16 months' observation in the BI early group was a reduction of 8.4 (5.4-11.4) headache and 13.5 (9.6-17.3) medication days per month. The relapse rate into medication overuse was 8.3%. Patients in the BI late group also improved significantly after a BI. BAU showed no significant improvement.

Conclusions: Treatment for MOH in primary care through a BI is a simple intervention with lasting effects and low relapse rate. This approach may be a logical first step in MOH treatment, and referral should generally be reserved for primary care non-responders.

Keywords: RCT; chronic headache; general practice; medication-overuse headache; migraine.

Publication types

  • Pragmatic Clinical Trial

MeSH terms

  • Adult
  • Cross-Over Studies
  • Double-Blind Method
  • Female
  • Follow-Up Studies
  • General Practitioners
  • Headache Disorders, Secondary / psychology
  • Headache Disorders, Secondary / therapy*
  • Humans
  • Male
  • Middle Aged
  • Norway
  • Primary Health Care
  • Recurrence
  • Treatment Outcome