Page 62 - The clinical aspects and management of chronic migraine Judith Anne Pijpers
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Chapter 3
patients with migraine alone, which may suggest that the pathophysiological mechanism of medication overuse differs between different underlying primary headache syndromes.
Nowadays the view on treatment of MOH shifts from the traditional ‘withdrawal therapy first’ towards an approach in which prophylactic therapies are started before patients are withdrawn from the overused medication. Randomised trials in chronic migraineurs with topiramate and onabotulinum toxin A,21–23 contributed significantly to the debate whether, and when, detoxification is necessary in the treatment of MOH.24 From these trials the question remains, however, whether the effect is clinically relevant. Moreover, the studies lack adequate reporting of plausible blinding failure, and most importantly, in these trials withdrawal was not advocated. To illustrate, the responder rate of migraineurs in our study is comparable to the responder rate in the pooled results of the onabotulinum toxin A trials. We realize that in our population not many patients overuse barbiturates or opiates, which enables acute medication withdrawal, in accordance with our national guidelines. Nevertheless, our study shows that with the support of a headache nurse, comprising only one face-to- face contact and a median of three contacts by telephone, 75% of MOH patients succeed to undergo a highly cost-effective outpatient withdrawal therapy, which is easily implemented in general neurology practice.
Withdrawal therapy is an effective treatment for Medication Overuse Headache especially for patients with migraine. Support by a headache nurse provides a substantial increase of treatment adherence and can be applied in an outpatient setting.
Acknowledgements
The authors thank Mrs. J. Trouerbach, headache nurse, for supporting MOH patients during withdrawal therapy.
Clinical implications
· With support of a headache nurse, almost 75% of Medication Overuse Headache patients succeed to withdraw from overused medication.
· Withdrawal therapy with support of a headache nurse is applicable in an outpatient setting in general neurology practice
· Medication Overuse Headache patients with migraine as the solely underlying primary headache disorder benefit the most by simple withdrawal therapy.
























































































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