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Table 17 Table 17

From: Reference programme: Diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 2nd Edition, 2012

Pharmacological treatment of medication overuse headache

Support medicine may be needed during the first week and the following may then be used:

• Levomepromazine 12.5–25 mg as needed maximally three times per day or promethaxine 25 mg x as needed maximally three times per day for a week followed by rapid tapering off (1–2 weeks)

• Metoclopramide suppositories 20 mg in case of severe nausea and vomiting

• Phenobarbital 100–200 mg × 2–3 for the first 4–5 days in case of severe withdrawal symptoms after discontinuation of opioids/combination medicines. After opioid overuse, methadone 20 mg may be needed and should then be tapered off over a 4-day period

After 2 months

• Initiation of prophylactic medication in accordance with standard guidelines depending on the type of headache

• Thorough information to the patient on the correct use of acute and prophylactic medical treatment

• Previously used medication, which during the medication overuse period had no effect, may now have effect

• Close follow-up at GP or specialist to avoid relapse into medication overuse

• Limited re-initiation of attack medication