Migraine chronification and medication-overuse headache (MOH) develop through a vicious cycle of increased migraine frequency, increased acute medication use, and less relief by acute medications, driving further attack frequency and disability,1–3 said Professor Gisela Terwindt, Leiden, The Netherlands.
Up to 70% of patients with chronic migraine develop medication-overuse headache4
Health care professionals should be aware of the risk factors associated with migraine chronification and MOH. These include allodynia (the perception of pain upon a non-painful stimulus to the skin) and hypersensitivity to pain,5 co-morbid depression and anxiety6 and medication overuse,2 added Professor Terwindt.
A patient-centric approach is key for managing medication-overuse headache
Several risk factors are associated with the development of migraine and medication-overuse headache
Not only does MOH affect patient functioning and quality of life,7 said Professor Christofer Lundqvist, Oslo, Norway, but the “overuse” terminology can add to the patient’s burden by suggesting dependence and addiction.8
A patient-centric non-stigmatizing approach can benefit patients and a brief intervention approach can help patients reduce medication use and headache frequency in patients with MOH,9 explained Professor Lundqvist.
A patient-centric non-stigmatizing, brief intervention approach can reduce medication overuse and headache frequency
Medication-overuse headache is stigmatizing and affects patient function and quality of life
Steps in the strategy include:
- Identifying and individualizing the risk
- Providing information about the need to decrease use of acute medications
- Information about the potential gains and challenges (including worsening of the headache over 1–2 weeks before improvement)
- An agreed treatment plan based on joint decision-making between the patient and the clinician, with support as necessary7
The role of preventive medication in the management of medication-overuse headache
Withdrawal therapy combined with preventive medication from the start of withdrawal is effective in patients with chronic migraine and medication-overuse headache
Evidence for the most appropriate treatment strategy for each individual patient is lacking, said Dr Patricia Pozo-Rosich, Barcelona, Spain. However, a comparison of three strategies — withdrawal with preventive, preventive and potential withdrawal, and withdrawal with potential preventive — has shown that withdrawal therapy combined with preventive medication from the start of withdrawal is most effective.10
The current European Academy of Neurology guidelines acknowledge the role of preventive therapy in migraine with medication-overuse headache, added Dr Pozo-Rosich. They recommend that patients with MOH for whom education is not effective should be withdrawn from overused drugs and receive preventive treatment with drugs of proven efficacy.4
New clinical studies designed to evaluate the role of preventive medication in migraine with medication overuse are warranted
Dr Pozo-Rosich also reviewed evidence for the efficacy of monoclonal antibodies against calcitonin gene related polypeptide in the prevention of migraine and medication overuse. However, studies specifically designed to assess the role of preventive medications in migraine with medication overuse are needed, concluded Dr Pozo-Rosich.
This satellite symposium was sponsored by Lundbeck.