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CONy 2024 | Medication overuse headache: is detoxification necessary?

Alan Rapoport, MD, University of California, Los Angeles, CA, discusses the ongoing debate regarding whether detoxification is necessary when treating medication overuse headache (MOH). Several different approaches are used to treat MOH, with a lack of clear evidence as to which method is optimal. Management approaches include: discontinuation of the overused medication before starting preventive therapy after the 2 month withdrawal period; preventive therapy initiation at the time of overused medication withdrawal; or initiation of preventive therapy while continuing overused medication. Prof. Rapoport argues that the introduction of new and effective preventive treatment options, such as CGRP monoclonal antibodies and gepants, has eliminated the need for detoxification. This differs from the traditional approach, which uses abrupt detoxification before being put on any preventive medicine. Prof. Rapoport believes his approach may optimal for patients and the evolving literature supports that formal detoxification may not always be necessary for successful treatment. This interview took place at the 18th Annual Congress on Controversies in Neurology (CONy 2024) in London, UK.

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