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Advice alone versus structured detoxification programmes for complicated medication overuse headache (MOH): a prospective, randomized, open-label trial

Paolo Rossi12*, Jessica Veronica Faroni1, Cristina Tassorelli2 and Giuseppe Nappi2

Author Affiliations

1 Headache Clinic, INI Grottaferrata, Via S.Anna s.n.c, 00046, Grottaferrata, Rome, Italy

2 Headache Science Centre, National Neurological Institute C. Mondino Foundation, Pavia, Italy

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The Journal of Headache and Pain 2013, 14:10  doi:10.1186/1129-2377-14-10

Published: 8 February 2013



The aim of this study was to compare the effectiveness of an educational strategy (advice to withdraw the overused medication/s) with that of two structured pharmacological detoxification programmes in patients with complicated medication overuse headache (MOH) plus migraine.


One hundred and thirty-seven complicated MOH patients participated in the study. MOH was defined as complicated in patients presenting at least one of the following: a) a diagnosis of co-existent and complicating medical illnesses; b) a current diagnosis of mood disorder, anxiety disorder, eating disorder, or substance addiction disorder; c) relapse after previous detoxification treatment; d) social and environmental problems; e) daily use of multiple doses of symptomatic medications. Group A (46 patients) received only intensive advice to withdraw the overused medication/s. Group B (46 patients) underwent a standard detoxification programme as outpatients (advice + steroids + preventive treatment). Group C (45 patients) underwent a standard inpatient withdrawal programme (advice + steroids + fluid replacement and antiemetics preventive treatment). Withdrawal therapy was considered successful if, after two months, the patient had reverted to an intake of NSAIDs lower than 15 days/month or to an intake of other symptomatic medication/s lower than 10 days/month.


Twenty-two patients failed to attend follow-up visits (11 in Group A, 9 in Group B, 2 in Group C, p < 0.03). Overall, we detoxified 70% of the whole cohort, 60.1% of the patients in Group A and in Group B, and 88.8% of those in Group C (p < 0.01).


Inpatient withdrawal is significantly more effective than advice alone or an outpatient strategy in complicated MOH patients.

Medication overuse headache; Management; Migraine; Treatment