Practical management of medication-overuse headache

Epidemiological studies suggest that medication-overuse as defined by the International Headache Society is extremely common in patients with chronic daily headache. If all medication-overuse produces medication-overuse headache (MOH) in headache patients, it would be the third most frequent form of headache, after tension-type headache and migraine. Treatment of MOH is hindered by the absence of placebo-controlled, double-blind, randomised clinical trials. Nevertheless, several headache centers worldwide have developed expertise in the treatment of this syndrome, and have been quite successful. Here, we summarize available data on MOH, including clinical features, drugs used in withdrawal, as well as withdrawal strategies that have been described in the literature. We also include a detailed description of an in-patient and out-patient withdrawal procedure, reflecting personal experience and opinion of the authors.