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 |