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Which drugs cause MOH?

The principal results of the project WP5 A and WP5B Rigmor Jensen, Danish Headache Center (DHC), Glostrup Hospital, University of Copenhagen, Denmark. Which drugs cause MOH?. Caffeine Ergotamine Dihydroergotamine Triptans Salicylates Acetaminophen. Paracetamol NSAIDs Codein

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Which drugs cause MOH?

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  1. The principal results of the projectWP5 A and WP5BRigmor Jensen, Danish Headache Center (DHC), Glostrup Hospital, University of Copenhagen, Denmark

  2. Which drugs cause MOH? Caffeine Ergotamine Dihydroergotamine Triptans Salicylates Acetaminophen Paracetamol NSAIDs Codein Opiates Tranquillisers Barbiturates Combinations are frequent All pain killers can cause HEADACHE

  3. ICHD-II - “Medication-Overuse Headache” II revision, 2006 … a system whereby medication overuse headache became a default diagnosis in all patients with medication overuse would encourage doctors all over the world to do the right thing, namely, to take patients off medication overuse as the first step in a treatment plan. • Headache present on ≥15 days/month • Regular overuse for >3 months of one or more acute/symptomatic treatment drugs as defined under sub form 8.2 • 1. Ergotamine, triptans, opioids or combination analgesic medications on ≥10 days/month on a regular basis for >3 months • 2. Simple analgesics or any combination of ergotamine, triptans, analgesics, opioids on ≥15 days/ month on a regular basis for > 3 months without overuse of any single class alone • C. Headache has developed or markedly worsened during medication overuse

  4. Objectives • Primary • Number of relapses in the two follow-up periods in the two arms • Secondary • Disease-related • Number of days with headache before and after detoxification in the two arms • Number of days with migraine before and after detoxification in the two arms • Number of days with tension-type headache before and after detoxification in the two arms • Number of days with other types of headache before and after detoxification in the two arms

  5. Overused drug at inclusion mean (SD) 5

  6. Headache Frequency(days/mth) Classical IEPR

  7. Major Results 9

  8. Critical issues with impact on the overall project results • IEPR not completed • Only preliminary results are presented • High number of patients screened, especially in IEPR • Selection of younger and IT-experienced patients in IEPR • More patients with chronic migraine in IEPR

  9. Preliminary conclusions • It is possible to conduct a multicenter EU-LA study in headache • Detoxification is very successfull and the headache frequency is significantly reduced • So far the relapse rate is relatively low • The burden and costs of MOH are significant • The overall impact on daily life, psychiatric comorbidity and QoL is improved after detoxification

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