Drug withdrawal along with bridge therapy with methylprednisolone and/or diazepam for treatment of medication overuse he
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Drug withdrawal along with bridge therapy with methylprednisolone and/or diazepam for treatment of medication overuse headache: a preliminary report from the WASH-OUT study Fabrizio Vernieri 1 & Patrizio Pasqualetti 1 & Matteo Paolucci 1 & Carmelina Maria Costa 1 & Nicoletta Brunelli 1 & Massimo Autunno 2 & Adriana Fallacara 1 & Gianluca Cecchi 1 & Sabina Cevoli 3 & Claudia Altamura 1
# Fondazione Società Italiana di Neurologia 2020
The best treatment for medication overuse headache (MOH) is still a matter of debate and, at present, several strategies are considered. There is a general agreement that withdrawing the overused drug is mandatory for the treatment of MOH. European guidelines recommend education about MOH followed by withdrawal and preventive medication [1]. Although some headache centers until recently took into consideration only complete discontinuation of analgesics for 2 months, a more recent study demonstrated that preventive medication combined with the withdrawal from the beginning is to be recommended for MOH [2]. On the other hand, withdrawal can be managed in association with a transitional therapy (i.e., bridge therapy) mainly with steroids, for their effect on nociception at various stages and to avoid abrupt suspension of painkillers. However, the role of steroid therapy is still debated. A study by Cevoli and colleagues [3] found no superiority of methylprednisolone 500 mg i.v. over paracetamol i.v. or placebo in a sample of severe MOH patients; regardless of the treatment used, withdrawal headache decreased significantly after 5 days of treatment, and most patients after 3 months had no longer medication overuse. WASH-OUT is an ongoing multicenter randomized singleblind prospective study. The study protocol was designed to compare different strategies used in several real-life settings
* Fabrizio Vernieri [email protected] 1
Unità Cefalee e Neurosonologia, Neurologia, Policlinico Universitario Campus Bio-Medico di Roma, Rome, Italy
2
Centro Cefalee, Policlinico G. Martino, Messina, Italy
3
IRCCS Istituto Scienze Neurologiche di Bologna, Bologna, Italy
together with MOH guidelines. We decided to use diazepam alone or add it to steroid, as benzodiazepines are effective in relieving anxiety symptoms and often used as relaxant during stressful medical procedures. Moreover, patients with chronic headaches have a high frequency of depression and anxiety disorders. Since the presence of psychiatric comorbidity contributes to poor quality of life and can influence prognosis and treatment, we included also a psychological assessment as an essential step both for the complete evaluation and to find the best treatment of MOH patients. Ten Italian centers have initially agreed to participate in the project; however, at present, only 2 started enrolling patients, mainly due to the fact that no-profit studies often find huge difficulties in taking out ad hoc patients’ insurance policy. The primary end point is to evaluate whether there is a superiority of one detoxi
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