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Table 6 Management of Medication Overuse Headache (MOH)

From: Consensus of the Hellenic Headache Society on the diagnosis and treatment of migraine

• For decision-making physicians should take into account the patients’ preferences, life-style particularities and personal expectancies.
• Physicians should educate patients for the mechanisms underlying the pathophysiology of MOH and the ways the patients should avoid overusing medications for treating their migraines.
• Depending on the patients’ personality, individual preferences and comorbidity, acute withdrawal or tapering down of the drug overuse is recommended.
• Immediate prophylactic treatment together with the drug overuse withdrawal or tapering down, is recommended as well, including topiramate 100-200 mg/day and prednisone or prednisolone 60 mg/d. The use of botulinumtoxinA and/or anti-CGRP monoclonal antibodies (erenumab, fremanezumab, and galcanezumab) is recommended, as second-line treatment.
• Not only migraine, but all potential comorbidities should also be treated.
• To treat anxiety and/or depression like symptoms that are highly likely to co-occur with MOH, venlafaxine 150 mg/df is recommended.
• Inpatient withdrawal therapy may be needed, in particular for patients overusing opioids, benzodiazepines, or barbiturates.
• Because the prognosis of MOH is poor and the relapse rate high, close follow-up of patients is recommended.
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