Two Promising Bridge Therapies for Medication Overuse Headaches

This study was published as a preprint and has not yet been peer reviewed.

Key Takeaway

  • Among patients with MOH of longer duration, response to treatment was lower, highlighting the importance of early diagnosis and rapid treatment for these headaches.

Why This Matters

  • MOH affects 1% to 2% of the general population. It is a burden both to patients and the medical system.

  • There is no established consensus for the management of MOH. Some centers rely on a bridge therapy to mitigate symptoms during withdrawal before beginning prophylactic treatment.

  • Previous investigations into bridge therapy have yielded inconsistent findings.

  • There is a need for additional research and a better understanding of how patient risk factors may affect therapy response.

Study Design

  • This was a retrospective, cross-sectional, single-center study.

  • The study used medical records of patients hospitalized at the headache tertiary center of Sina Hospital in Iran from March 2009 to June 2020.

  • Among the inclusion criteria for the study was being 18–60 years of age and having experienced at least one failed outpatient course of treatment.

  • MOH was defined in accordance with the International Classification of Headache Disorders–3. That definition specifies use of symptomatic or acute headache medication for over 15 days a month for at least 3 months.

  • A response to treatment was defined as an improvement of more than 50% in intensity, or duration longer than 72 hours post treatment. Response was categorized as ≥50%.

  • Data were analyzed with statistical software.

Key Results

  • The study included a total of 178 patients with MOH. The mean age of the patients was 43.29 years.

  • The majority of patients (82.5%) were women.

  • The mean duration of headache was 17.05 ± 11.83 years, and the mean duration of MOH was 2.67 ± 3.78 years.

  • For most patients (79.2%), the response rate was >50%.

  • For 37 patients (20.8%), the response rate was <50%. For those patients, the duration of MOH was longer than for the patients who had a better response to treatment (P = .05).

  • For all 94 patients who received methylprednisolone (P = .000) and for 70% of the patients treated with celecoxib (P = .01), the response rate was >50%.

  • Other interventions did now show this significant association for response, including IV valproate, GON block, intravenous (IV) magnesium therapy, indomethacin, or oral high-dose naproxen.

Limitations

  • The study used a retrospective design for data collection.

  • The study lacked a control group, which may have introduced biases.

  • Additional variables, including special biomarkers or genetic factors, were not accounted for in the study and may have been related to treatment response.

Disclosures

  • The study received no specific funding from public, commercial, or not-for-profit sources.

  • The authors have disclosed no relevant financial relationships.

This is a summary of a preprint research study, “Response to Bridge Phase Treatment in Medication Overuse Headache,” written by Mansoureh Togha from Tehran University of Medical Sciences and colleagues. This study from Research Square is provided to you by Medscape. The study has not yet been peer reviewed. The full text of the study can be found on researchsquare.com.

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