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Table 18 Pharmacological treatment for medication overuse headache

From: Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020

Rescue medication in week 1–3 of the withdrawal may be needed:
• Tablet levomepromazine 12.5–25 mg as needed max. 75 mg/day, or tablet promethazine 25 mg as needed max. 75 mg/day.
• Tablet metoclopramide 10 mg or tablet domperidone 10 mg against nausea as needed max. 30 mg/day.
• In case of opioid- or barbiturate overuse: Tablet methadone, e.g. 20 mg, dosage decreased over next 4 days (only in-patient care).
• Early start of preventive headache medication simultaneously with start of withdrawal should be considered
After 2 months of withdrawal
• If not started earlier, start of preventive headache medication should be started.
• Detailed information to the patient about correct use of short-term medication, preventive medication, and headache calendar to prevent relapse.
• Treatments that previously were ineffective due to medication overuse, may become effective after withdrawal.