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

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.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).Inpatient withdrawal is significantly more effective than advice alone or an outpatient strategy in complicated MOH patients.Medication overuse headache (MOH) is a relevant public health problem worldwide [1,2]. Population-based studies in several European countries have reported prevalence rates of MOH ranging from 0.9 to 1.8%, making it the third most frequent headache disorder after tension-type headache and migraine [3-7].Medication overuse headache has detrimental effects on patients’ quality of life and it places a high economic burden on society [1,2].The recently published findings of the Eurolight project show that the mean per-person annual costs of MOH are 3