Preliminary results of a withdrawal and detoxification therapeutic regimen in patients with probable chronic migraine and probable medication overuse headache

Chronic migraine (CM) isan invalidating condition affecting asignificant population of headachesufferers, frequently associated withmedication overuse headache(MOH). Controlled trials and guidelinesfor the treatment of MOH arecurrently not available. We studiedthe efficacy of a therapeutic regimenfor the withdrawal of the overuseddrug and detoxification in a sampleof patients suffering from probableCM and probable MOH duringadmission in eight hospitals ofPiemonte–Liguria–Valle d’Aosta.Fifty patients, 42 females (84%) and8 males (16%), mean age at observation50.66±13.08 years, affected byprobable CM and daily medicationoveruse following IHS diagnosticcriteria were treated as inpatients orin a day hospital. Headache index(HI) and daily drug intake (DDI)were used for evaluating the severityof headache and medication overuse.The patients were treated by abruptdiscontinuation of the overused drugand by a therapeutic protocol includingi.v. hydration, dexamethasone,metoclopramide and benzodiazepinesfor 7–10 days. Prophylactic medicationwas started immediately afteradmission. Analgesics or triptanswere used under medical controlonly in cases of severe reboundheadache. Diagnostic protocolincluded routine blood tests (atadmission and at discharge), dosageof B12 and folic acid. Patientsunderwent follow-up controls one,three and six months after discharge.The initial diagnosis was probableCM in almost all patients included inthe study (41 patients); in ninepatients the diagnosis was not specified(coded only as CDH). Theoverused medications were simpleanalgesics in 17 cases (34%), combinationanalgesics in 19 cases (38%),triptans alone or with analgesics in13 cases (26%) and ergotamine in 2cases (4%). We collected data from39 patients at first follow–up (1month), 32 after 3 months and 14after 6 months. Mean HI was 0.91 atadmission, 0.22 at discharge, 0.38after 30 days, 0.46 after 3 monthsand 0.48 after 6 months. Mean DDIwas 2.80 at admission, 0.39 at discharge,0.41 after 1 month, 0.52 after3 months and 0.59 after 6 months.These results are on average positiveand tend to remain stable with time.Although preliminary and obtainedon a limited number of patients at 6–month follow–up, our results seem tobe encouraging about the use of theproposed therapeutic protocol.