OBJECTIVE: to evaluate the efficacy of methylprednisolone or paracetamol in withdrawal headache in MOH patients.BACKGROUND: Withdrawal headache in MOH is a therapeutic challenge.DESIGN/METHODS: weperformed a randomized, single-blinded, placebo controlled trial. MOH patients, unresponsive to prophylaxis in a three months run-in period, underwent withdrawal therapy on an in-patient basis. Overused medications were suddenly stopped and methylprednisolone 500mg i.v (A) or paracetamol 4g i.v. (B) or placebo i.v. (C) were given daily for 5 days. Severity of headache and of autonomic symptoms was reported in daily diaries. Metoclopramide and/or lorazepam were allowed as rescue medications. Chi-square and ANOVA-oneway tests were used.RESULTS: 80 consecutive patients were enrolled: 6 patients refused hospitalization, 20 recovered in the run in period. 54 pts (49 F, 5 M; mean age 46.7±10.1) completed the study protocol. Overused medications included triptans (66.7%), simple analgesics (33.3%), combination analgesics (29.6%). No differences about overused drugs, time of overuse , days of headache (23.1±6.6) and days of overuse per month (23.1±6.8)were found. 8 patients were randomized to A, 17 to B and 19 to C. Withdrawal headache on the 5th day was absent in 4 patients (22.2%) of A, in 5 patients (29.4%) of B and 4 (21.1%) of C (p>0.5). Mean headache intensity was significantly lower in A and B Vs C both on the 2nd and 3th days (p =0.05; p=0.49). The three groups did not differ in autonomic symptoms. The mean number of rescue medications was lower in the A (3.2±2.7) and B (1.7±1.5) Vs C (4.9±4.7; p=0.02). After one month of follow-up 34 patients (68%) returned to an episodic migraine, 8 of those relapsed to MOH after three months from withdrawal.CONCLUSIONS: our data suggest that methylprednisolone and paracetamol are superior to placebo in reducing the intensity of rebound headache on the second and third day of withdrawal, and in reducing the consumption of rescue drugs in MOH patients.Study Supported by: /
Disclosure: Dr. Cevoli has nothing to disclose. Dr. Giannini has nothing to disclose. Dr. Favoni has nothing to disclose. Dr. Sancisi has nothing to disclose. Dr. Nicodemo has nothing to disclose. Dr. Zanigni has nothing to disclose. Dr. Grimaldi has nothing to disclose. Dr. Pierangeli has nothing to disclose. Dr. Cortelli has received personal compensation for activities with Allergan Inc., Boehringer Ingelheim Pharmaceuticals Inc., Chelsea Therapeutics, GlaxoSmithKline Inc., Lundbeck Research USA Inc., and Merck Sharp & Dohme Ltd.
Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/I9-1.010?rss=1
No comments:
Post a Comment