Combined Strategies Best for Medication-Overuse Headache, Network Meta-Analysis Finds
Combination therapies were most effective for reducing monthly headache days in patients with medication-overuse headache, also known as rebound headache, according to a network meta-analysis published in The Journal of Headache Pain.
“While headache prevention strategies demonstrated similar efficacy, abrupt withdrawal alone was insufficient,” wrote corresponding author Prut Koonalintip, of Prince of Songkla University, Hat Yai, Thailand, and study coauthors.
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The network meta-analysis included data from 16 randomized controlled trials that compared strategies for the management of medication-overuse headache. The trials spanned a total 3000 adult patients and included withdrawal strategies such as bridging therapies, the use of concurrent migraine prevention medications, and added education.
Combination therapies demonstrated the greatest efficacy for improving monthly headache days, according to the study. In particular, headache days per month decreased 10.6 days with abrupt withdrawal plus oral prevention plus greater occipital nerve blocks compared with control interventions. Monthly headache days fell 8.47 days with restriction of overused acute medication plus oral prevention plus calcitonin gene-related peptide (CGRP) therapies compared with controls.
Most headache prevention strategies, including oral prevention, anti-CGRP receptor therapies, and botulinum toxin, significantly reduced monthly headache days. However, no single initial prevention strategy showed superior efficacy over the others.
“Given the lack of significant differences in efficacy among these strategies, the choice of headache prevention should be considered by patient preferences, tolerability, comorbidities, contraindications, and costs,” researchers wrote, “to ensure suitability for individual patients.”
Among withdrawal strategies, abrupt withdrawal alone showed no significant efficacy. Researchers reported a mean difference of 2.77 fewer headache days per month compared with control. The effect of education in the trials was generally positive.
“These findings suggested that the efficacy of MOH [medication-overuse headache] treatments could improve when education is integrated with overused drug withdrawal and/or pharmacological therapies,” researchers wrote.
