A randomized controlled trial on medication-overuse headache: outcome after 1 and 4 years

Background - Different opinions exist regarding the optimal treatment of patients with medication-overuse headache (MOH). Few studies have evaluated the long-term prognosis among these patients, and there are no standard measures of outcome in such studies. Aim - To summarize the 1- and 4-year outcome of patients with MOH previously included in a randomized follow-up study. Material and methods Sixty-one patients with MOH were randomly assigned to receive either preventive treatment from day 1 without detoxification, a standard out patient detoxification program without preventive treatment from day 1, or no specific treatment. Sixty patients still alive were invited to a 4-year follow-up, whereof 50 (83%) participated. Results - Early introduction of preventive treatment effectively reduced headache days and in particular headache suffering both during the first months and at 12-month follow-up. At 4-year follow-up, 16 persons (32%) were considered as responders (i.e. >= 50% reduction in headache frequency from baseline), whereas 17 persons (34%) met the criteria for MOH. None of the baseline characteristics consistently influenced all five outcome measures. Discussion - Early introduction of prophylactic medication was an effective way to reduce headache days during the first 3 months, and the notion that patients with MOH need withdrawal of analgesics to respond to preventive medication seems to be incorrect. The long-term prognosis during the 4-year follow-up was relatively favorable as there was a steady decline in headache, one-third of the patients with MOH having >= 50% reduction in headache frequency from baseline and two-thirds being without medication overuse.