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Table 4 Published recommendations for outpatient and inpatient withdrawal from headache medication

From: A narrative review on the management of medication overuse headache: the steep road from experience to evidence

 

Inpatient

Outpatient

Pamelaire et al. [12]

Drugs (opioids/barbiturates)

Status migrainosus

Severe vomiting/dehydration

Social situation

Previous failure as outpatient

Psychiatric comorbidity

Physical comorbidity

Fear of drug interactions

Motivated patients

Mild-moderate overuse

German Migraine and Headache Society (1999)

Obermann and Katzarava [14]

Drugs (codeine, barbiturates, tranquillisers)

Depression

Previous medication withdrawal failure

Drugs (monosubstances, analgesic mixture not containing barbiturates or codeine)

Highly motivated patients

Possibility of daily follow-up visits

Overall good compliance

British Association for the Study of Headache (2007)

Drugs (overuse of high doses of opioids/barbiturates/benzodiazepines)

Presence of psychiatric/behavioural disturbances

(in these cases the authors recommend referral to specialist units or pain management clinics offering neurological and psychiatric services)

No specific indication (the authors state that admission to a hospital is rarely necessary)