Neurological Sciences

, Volume 30, Supplement 1, pp 85–88 | Cite as

Treatment of chronic migraine with medication overuse: is drug withdrawal crucial?

  • Licia GrazziEmail author
  • Frank Andrasik
  • Susanna Usai
  • Gennaro Bussone


Chronic headaches have increasingly become a focus within the field of head pain. For the most part patients with frequent headaches eventually overuse their medications, and if it happens (the percentage is approximately 4%), the diagnosis of chronic migraine with medication overuse headache is clinically important, because patients rarely respond to preventive medications whilst overusing acute medications. Properly treating medication overuse with adequate strategies is an essential component for helping these patients to improve and for preventing relapses. The necessity of withdrawal performed by different treatment schedules, outcomes, and the long-term durability of treatment are discussed.


Chronic headache Medication overuse headache Withdrawal protocols 


Conflict of interest statement

The authors declare that they have no conflict of interest related to the publication of this manuscript.


  1. 1.
    Diener HC, Limmroth V (2004) Medication overuse headache: a worldwide problem. Lancet Neurol 3:475–483PubMedCrossRefGoogle Scholar
  2. 2.
    Headache Classification Subcommittee of the International Headache Society (2004) The International Classification of Headache Disorders. Cephalalgia 24:Suppl 1Google Scholar
  3. 3.
    Diener HC, Mathew NT (2000) Drug induced headache. In: Diener HC (ed) Drug treatment of migraine and other frequent headaches, vol 17. Karger Press, Basel, pp 347–356Google Scholar
  4. 4.
    Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB (2004) Transformed migraine and medication overuse in a tertiary headache centre–clinical characteristics and treatment outcomes. Cephalalgia 24:483–490PubMedCrossRefGoogle Scholar
  5. 5.
    Mathew NT, Kailasam J, Meadors L (2002) Prophylaxis of migraine, transformed migraine and cluster headache with topiramate. Headache 42:796–803PubMedCrossRefGoogle Scholar
  6. 6.
    Hagen K, Albretsen C, Vilming ST, Salvesen R, Gronnin M, Helde G, Gravdahl G, Zwart JA, Stovner LJ (2008) Management of medication overuse headache: 1 year randomized multicentre open-label trial. Cephalalgia 29:221–232PubMedCrossRefGoogle Scholar
  7. 7.
    Grazzi L, Andrasik F, D’Amico D, Usai S, Kass S, Bussone G (2004) Disability in chronic migraine patients with medication overuse: Treatment effects at 1 year follow-up. Headache 44:678–683PubMedCrossRefGoogle Scholar
  8. 8.
    Grazzi L (2008) Behavioural approach to the difficult patient. Neurol Sci 29:S96–S98PubMedCrossRefGoogle Scholar
  9. 9.
    Freitag F, Lake AL III, Lipton R, Cady R, Diamond S, Silberstein S (2004) Inpatient treatment of headache: an evidence-based assessment. Headache 44:342–360PubMedCrossRefGoogle Scholar
  10. 10.
    Lake AEIII, Saper J, Madden S, Kreeger C (1993) Comprehensive inpatient treatment for intractable migraine: a prospective long-term outcome study. Headache 33:55–62PubMedCrossRefGoogle Scholar
  11. 11.
    Krymchantowski AV, Barbosa JS (2000) Prednisone as initial treatment of analgesic-induced daily headache. Cephalalgia 20:107–113PubMedCrossRefGoogle Scholar
  12. 12.
    Raskin NH (1986) Repetitive intravenous diydroergotamine as therapy for intractable migraine. Neurology 36:995–997PubMedGoogle Scholar
  13. 13.
    Diener HC, Haab J, Peters C, Ried S, Dichgans J, Pilgrim A (1990) Subcutaneous sumatriptan in treatment of headache during withdrawal from drug-induced headache. Headache 31:205–209CrossRefGoogle Scholar
  14. 14.
    Hering R, Steiner TJ (1991) Abrupt outpatient withdrawal of medication in analgesic-abusing migraineurs. Lancet 337:1442–1443PubMedCrossRefGoogle Scholar
  15. 15.
    Krymchantowski AV, Moreira PF (2003) Outpatient detoxification in chronic migraine: comparison of strategies. Cephalalgia 23:982–993PubMedCrossRefGoogle Scholar
  16. 16.
    Pini LA, Bigarelli M, Vitale G, Sternieri E (1996) Headaches associated with chronic use of analgesic: a therapeutic approach. Headache 36:433–439PubMedCrossRefGoogle Scholar
  17. 17.
    Grazzi L, Andrasik F, Usai S, Bussone G (2008) In-patient vs day-hospital withdrawal treatment for chronic migraine with medication overuse and disability assessment: results at one year follow-up. Neurol sci 29(Suppl 1):S161–S163PubMedCrossRefGoogle Scholar
  18. 18.
    Grazzi L, Andrasik F, D’Amico D, Leone M, Usai S, Kass S, Bussone G (2002) Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years. Headache 42:483–490PubMedCrossRefGoogle Scholar
  19. 19.
    Baumgartner C, Wessely P, Bingol C, Maly J, Holzner F (1989) Longterm prognosis of analgesic withdrawal in patients with drug-induced headaches. Headache 29:510–514PubMedCrossRefGoogle Scholar
  20. 20.
    Monzon M, Lainez M (1998) Quality of life in migraine and chronic daily headache patients. Cephalalgia 18:638–643PubMedCrossRefGoogle Scholar
  21. 21.
    Silberstein SD, Silberstein JR (1992) Chronic daily headache: long-term prognosis following inpatient treatment with repetitive IV DHE. Headache 32:439–445PubMedCrossRefGoogle Scholar
  22. 22.
    Schnider P, Aull S, Baumgartner C, Marterer A, Wober C, Zeiler K, Wessely P (1996) Long-term outcome of patients with headache and drug abuse after inpatient withdrawal: five-year follow-up. Cephalalgia 16:481–485PubMedCrossRefGoogle Scholar
  23. 23.
    Andrasik F, Grazzi L, Usai S, D’Amico D, Kass S, Bussone G (submitted) Disability in chronic migraine with medication overuse: treatment effects through 5 yearsGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Licia Grazzi
    • 1
    Email author
  • Frank Andrasik
    • 2
  • Susanna Usai
    • 1
  • Gennaro Bussone
    • 1
  1. 1.Neurological Institute C. BestaMilanItaly
  2. 2.Department of PsychologyUniversity of West FloridaPensacolaUSA

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