EHC 2023 | Best approach to management of medication-overuse headache

Sait Ashina, MD, Harvard Medical School, Boston, MA, comments on the evaluation and management of medication-overuse headaches (MOH), particularly the ongoing debates surrounding the early introduction of preventive treatment. MOH is classified as a chronic headache disorder secondary to a pre-existing headache syndrome, in which headache occurs on 15 or more days per month in a patient with regular medication overuse for greater than three months. Withdrawal of the overused medication is key to MOH treatment, but the optimal approach remains unclear. Management approaches include: discontinuation of the overused medication before starting prophylactic therapy after the 2 month withdrawal period; prophylactic therapy initiation at the time of overused medication withdrawal; or initiation of prophylactic therapy while continuing overused medication. Transitional medications can also be used to help prevent withdrawal symptoms. Dr Ashina references several studies aimed at investigating the best withdrawal strategy to overcome medication overuse, which showed similar outcomes across the different approaches. Given its preventable nature, an emphasis on patient education is key. This interview took place during the 7th European Headache Congress (EHC) 2023.

These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.