The effectiveness of treatments for patients with medication overuse headache; a systematic review and meta-analysis

Abstract Worldwide, about 1–2% of the adult population suffers from chronic headache due to overuse of pain medication. Guidelines recommend acute withdrawal of medication, but the optimal treatment remains unknown. We aim to evaluate the benefit of treatments for patients with medication overuse headache (MOH). We performed an extensive literature search until November 2015, selecting randomized controlled trials that evaluated interventions for adults with MOH. Two authors assessed the eligible trials and extracted data. We calculated effect estimates and used the random effects model for the pooled analysis. Our primary outcome measures were ‘headache days’ and ‘days with medication.’ Outcome data were categorised as short term (up to 12 weeks) or long term (12 weeks or over) outcomes. This review consists of 16 trials including 1105 patients. Four trials evaluated the use of prednisone with placebo or celecoxib after medication withdrawal; seven trials evaluated various methods of withdrawal versus other methods of withdrawal and five trials evaluated prophylactic medication compared with placebo or ibuprofen. We found no significant differences in headache days between prednisone versus placebo or between outpatient versus inpatient treatment, but we found a significant difference in days with medication. Overall, we found no benefit of prophylactic medication versus placebo. We found low to very low quality of evidence of no benefit of prednisone, prophylaxis and various withdrawal interventions. Since the burden of medication overuse headache for patients is enormous, larger and high quality intervention trials are needed.