The abrupt outpatient withdrawal of symptomatic medications improve the headache in chronic migraine patients. A prospective study

Patients with chronic migraine (CM) frequently overuse symptomatic medications (SM). This creates a cycle of rebound and withdrawal symptoms that transforms the headache into a daily or near-daily presentation. Some also believe this profile of overusing SM is responsible for the inefficacy of preventive treatments among these patients. We studied prospectively 50 patients (42 W, 8 M) fulfilling the Silberstein et al (1994, 1996) proposed criteria for CM with SM overuse. The patients were clearly oriented, had to stop their SM and initiated the same preventive treatment from the seventh day on. In addition, they didn’t had anything to take during the first six days but were oriented to use indomethacin 100mg suppositories in a maximum of once a week or to call a 24- hour hotline in which they would be conducted to a clinicbased environment to receive IV clopromazine, as needed. After five weeks the patients had to return and headache, withdrawal symptoms and consumption of rescue medications were evaluated. Moreover, the frequency of the headache week-by-week and the reduction > 50% of the headache days were also evaluated. Forty-one patients (82%) returned and adhered to the proposed treatment. During the initial six days, 68,3% (n=28) of the patients presented severe headache, 97,5% (n=40) revealed withdrawal symptoms and 46,4% (n=19) of the patients used rescue medications. After five weeks, the headache frequency was significantly better (p=0.000), the patients had an overall decreasing in headache days by 43,4% and 63,4% (n=26) manifested a reduction > 50% in days with headache. We concluded that the sudden outpatient interruption of SM overused promotes headache exacerbation and withdrawal symptoms but it doesn’t impair the adherence to the treatment. In addition, the frequency of headache is decreased after five weeks of abstinence in the majority of the patients.

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