• Mia Nielsen, Louise Ninett Carlsen, Signe Bruun Munksgaard, Ida Maria Storm Engelstoft, Rigmor Højland Jensen, and Lars Bendtsen.
• Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark.
• Cephalalgia. 2019 Jun 1; 39 (7): 863-872.

BackgroundMedication-overuse headache leads to high disability and decreased quality of life, and the best approach for withdrawal has been debated.AimTo compare change in disability and quality of life between two withdrawal programs.MethodsWe randomized medication-overuse headache patients to program A (two months without acute analgesics or migraine medications) or program B (two months with acute medications restricted to two days/week) in a prospective, outpatient study. At 6 and 12 months, we measured disability and headache burden by the Headache Under-Response to Treatment index (HURT). We estimated quality of life by EUROHIS-QOL 8-item at 2-, 6-, and 12-month follow-up. Primary endpoint was disability change at 12 months.ResultsWe included 72 medication-overuse headache patients with primary migraine and/or tension-type headache. Fifty nine completed withdrawal and 54 completed 12-month follow-up. At 12-month follow-up, 41 patients completed HURT and 38 completed EUROHIS-QOL 8-item. Disability reduction was 25% in program-A and 7% in program-B ( p = 0.027). Headache-burden reduction was 33% in program-A and 3% in program-B ( p = 0.005). Quality of life was increased by 8% in both programs without significant difference between the programs ( p = 0.30). At 2-month follow-up, quality of life increased significantly more in program-A than program-B ( p = 0.006).ConclusionBoth withdrawal programs reduced disability and increased quality of life. Withdrawal without acute medication was the most effective in reducing disability in medication-overuse headache patients.Trial RegistrationClinicaltrials.gov (NCT02903329).

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