Medication Overuse Headache Responds to Steroid, Benzodiazepine Bridge Therapy

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At day 5, the majority of patients in the treatment group were headache-free.
At day 5, the majority of patients in the treatment group were headache-free.

In patients with medication overuse headaches, bridge therapy with intravenous (IV) methylprednisone and diazepam was shown to reduce headache pain and painkiller intake up to 3 months after withdrawal, according to research published in Neurological Sciences.1

Researchers retrospectively evaluated 94 patients with chronic migraine and medication overuse headache. A total of 46 patients underwent detoxification with a 5-day IV infusion of methylprednisone and diazepam in a day-hospital setting. The remaining patients refused detoxification therapy (n=48), primarily due to difficulties with receiving the therapy over the 5 days.

At day 5, the majority of patients in the treatment group were headache-free (82%), and only 36% had headaches on >3 days during treatment.

After adjusting for covariates, researchers reported that the treatment had a significantly greater effect on headache frequency (P =.001) and drug consumption (P <.001) compared with no intervention in the 3 months following the withdrawal.

The adjusted decrease in headaches was 9.4 monthly headache days in the treatment groups compared with 3.0 monthly headache days in the control group. Drug consumption decreased by 19.7 in the intervention group and 6.5 in the control group. Moreover, patients who participated in the intervention were more likely to have a >50% reduction in monthly headaches (P =.02) and a decrease in symptomatic drug consumption (P <.001).

The study investigators concluded that "patients with [medication overuse headache] who undergo a steroid and benzodiazepine-based bridge therapy during withdrawal of symptomatic drugs have a larger benefit on headache days and symptomatic drug consumption at 3 months after the intervention than patients who do not."

Reference

Paolucci M, Altamura C, Brunelli N, et al. Methylprednisolone plus diazepam i.v. as bridge therapy for medication overuse headache [published online September 6, 2017]. Neurol Sci. doi:10.1007/s10072-017-3098

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