Institute or federation | Positive stopping rules | Negative stopping rules | Treatment |
---|---|---|---|
National Institute for Health and Care Excellence [56] | Discontinue treatment when a patient has regressed from CM to EM over three consecutive months | Discontinue treatment when a patient does not achieve a reduction of 30% or more in MHDs after two treatment cycles | OnabotulinumtoxinA |
European Headache Federation expert consensus [57] | Stop treatment if a patient reaches a reduction to fewer than 10 headache days per month for three consecutive months. Re-evaluate after four to five months | Stop treatment if a patient does not respond during the first two to three treatment cycles | OnabotulinumtoxinA |
American College of Physicians and American Academy of Family Physicians [58] | After a period of stability, clinicians are advised to consider tapering or discontinuing treatment, taking into account the patient’s wishes and expectations |  | All preventatives |
British Association for the Study of Headache [59] | Consider gradual withdrawal after 6 to 12Â months of effective prophylactic treatment | Â | All preventatives |
Canadian Headache Society [60] | After 6 to 12Â months of successful prophylactic therapy, consider tapering and discontinuing the prophylactic medication | A prophylactic medication should be administered for at least two months at the maximum tolerated, target, or optimal dose before being considered ineffective | All preventatives |