Medication-overuse headache (MOH) happens when chronic headache patients see a worsening of their headaches, and react by using more acute medication, including NSAIDs and triptans. This in turn can exacerbate the headaches rather than ease the pain. MOH is defined by the occurrence of headache on at least 15 days per month, along with the use of triptans on 10 days or more days per month or NSAIDs on at least 15 days per month.
A new protocol for management of MOH has been established by the joint European/Latin American COMOESTAS study. “These findings confirm the efficacy, the usability worldwide, and the low economic cost of detoxifying patients with medication-overuse headache,” said Cristina Tassorelli, MD, PhD, in presenting the COMOESTAS data at the Third European Headache and Migraine Trust International Congress.
The protocol used in COMOESTAS (Continuous Monitoring of Medication-Overuse Headache in Europe and Latin America: Development and Standardization of an Alert and Decision Support System) is comprised of several factors: abrupt detoxification of the acute medication, patient education, early initiation of individualized prophylactic therapy, and regular scheduled follow-up by one physician led by electronic support. An electronic medical diary is maintained by the patient, which automatically signals their physician if they are in danger of relapsing. Alan Rapoport, MD, Clinical Professor of Neurology at the David Geffen School of Medicine at UCLA said, “The multi country COMOESTAS study has demonstrated once more that these difficult-to-treat patients can be successfully weaned from their overused medication and improve considerably. What I like about this study is that it encourages doctors all over the world to follow a simple protocol to help patients with a complex problem”……. Neurology Reviews January 2013