A Critical Evaluation on MOH Current Treatments
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Migraine is the most frequent neurological disorder observed in clinical practice characterized by moderate to severe pain attacks associated with neurological, gastrointestinal, and dysautonomic symptoms. Each year, 2.5% of patients with episodic migraine develop chronic migraine (CM). CM is characterized by high frequency of the attacks that may result into chronic intake of abortive medications. Nearly, the 70% of CM patients referring to tertiary head centers show acute pain medications overuse that may lead to the development of medication overuse headache (MOH). The management of MOH requires three steps: (1) education, (2) withdrawal of the overuse drug and detoxification, and (3) re-prophylaxis. In the last years, several real-life prospective studies provided further evidence in clinical setting of the onabotulinumtoxinA 155–195 U efficacy for the headache prophylaxis in CM with MOH patients. There is a general agreement on two factors: (1) withdrawal of the overuse drug is condicio sine qua non to reverse the pattern to medium–low-frequency migraine, and (2) the focus of management needs to shift from acute treatment of pain to prevention of headache. CM patients close to developing MOH, patients with high-frequency episodic migraine, and those already abusing of drugs require special attention and should refer to tertiary headache centers. For all of them, a solution could be an “early treatment.” Early should be their referral to a tertiary headache center, early should be the withdrawal of the overuse drug and a proper detoxification, and perhaps early should be the start of a preventative therapy.
KeywordsChronic migraine Medication overuse headache Migraine acute drugs overuse Preventative therapy Early treatment OnabotulinumtoxinA
Andrea Negro, Martina Curto, Luana Lionetto, and Simona Guerzoni participated in the search of the background literature and writing of the paper.
Andrea Negro, Simona Guerzoni, Luigi Alberto Pini, and Paolo Martelletti participated in the conception and critical discussion of the paper.
All authors approved the final draft.
Compliance with Ethical Standards
Conflict of Interest
Martina Curto and Luana Lionetto declare that they have no conflict of interest.
Andrea Negro received travel grants, honoraria, and participated in the advisory board of Allergan and Electrocore.
Simona Guerzoni participated in the advisory board of Allergan.
Luigi Alberto Pini participated in the advisory board of Allergan and Mylan.
Paolo Martelletti received travel grants, honoraria, and consultancy, and participated in the advisory boards of Allergan and Teva.
The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
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