Table 4 Medication withdrawal in patients with medication overuse headache
From: Imaging the brain and vascular reactions to headache treatments: a systematic review
Reference | Population | Treatment | Imaging modality and timing of scans | Results | Limitations |
|---|---|---|---|---|---|
Fumal et al., 2006 [44] | 16 CM w/ MOH 68 HC | Type: Medication withdrawal | Modality: 18 FDG PET-MRI Time-point: Pre-withdrawal and at follow-up 3 weeks after withdrawal for patients HC underwent only one scan | Baseline: HC vs MOH ↓ Metabolism in bilateral thalamus, insula/ventral striatum, orbitofrontal cortex, and right posterior parietal cortex in MOH compared to HC ↑ Metabolism in the cerebellar vermis in patients compared to HC Baseline to follow-up: ↑ Metabolism in MOH in the insula, thalamus, parietal cortex, and cerebellum after withdrawal ↓ Metabolism in the orbitofrontal cortex persisted and was more pronounced after withdrawal in patients compared to HC | Uncorrected results and small volume correction for a priori selected ROIs Smaller sample of patients compared to the sample of HC No information regarding use of acute medications before the pre-withdrawal scan |
Ferraro et al., 2021 [45] | 8 MOH without medication withdrawal (MOH) 8 MOH with medication withdrawal (D-MOH) 8 CM 8 HC | Type: Medication withdrawal | Modality: Task-based fMRI w/ decision making Time-point: D-MOH had the MRI 6 months after withdrawal MOH, HC and CM underwent one MRI scan | Baseline: ↑ Activation in the bilateral ventromedial prefrontal cortex and precuneus in MOH compared to HC and D-MOH ↓ Activation in midbrain regions (substantia nigra/ventral tegmental area) in MOH compared to HC and CM patients ↓ Activation in midbrain regions (substantia nigra/ventral tegmental area) in D-MOH compared to HC No midbrain differences between MOH and D-MOH | Decision making involved a monetary gamble with unknown relation to medication intake |
Mehnert et al., 2018 [46] | 18 MOH 18 HC | Type: Medication withdrawal | Modality: Task-based fMRI w/ noxious trigeminal stimulus and T1w MRI Time-point: Pre-withdrawal and at follow-up 8 weeks after withdrawal HC underwent the same protocol of patients | fMRI—Baseline to follow-up: ↑ Activation of the left spinal trigeminal nucleus, right operculum, and posterior insula in MOH patients after withdrawal ↑ FC during nociception of the right medial orbital gyrus with the right spinal trigeminal nucleus and bilateral cerebellum in MOH patients after withdrawal No significant longitudinal functional differences between patients and controls VBM—Baseline to follow-up: ↓ GM volume of the left cuneus, superior temporal gyrus, putamen, and cerebellum in patients after withdrawal No significant longitudinal GM volume differences between patients and controls The absolute reduction in headache days was correlated with GM volume of right medial orbital gyrus in MOH | Uncorrected results with following application of FWE small volume correction No information regarding use of acute medications before the pre-withdrawal scan 11 patients started using preventive drugs for migraine during the study |
Ferraro et al., 2012 [47] | 9 MOH (all female) 9 HC (all female) | Type: Medication withdrawal | Modality: Task-based fMRI w/ painful stimulation of the left hand Time-point: Pre-withdrawal and at follow-up 6 months after withdrawal HC underwent only one MRI | Baseline: HC vs MOH ↑ Pain-related activation in primary somatosensory cortex, inferior parietal cortex, and supramarginal gyrus in MOH compared to HC Follow-up: HC vs MOH No difference in MOH compared to HC at follow-up | Small sample size Uncorrected results with following application of FWE small volume correction Extracephalic nociceptive stimulation |
Riederer et al., 2013 [48] | 22 MOH (11 responders, 11 non-responders) | Type: Medication withdrawal | Modality: T1w MRI Time-point: Pre-withdrawal and at follow-up 3 months after withdrawal | Baseline: Responders vs non-responders ↑ GM volume of the right orbitofrontal cortex in responders compared to non-responders Positive correlation between GM volume of the orbitofrontal cortex and patients´ treatment response Baseline to follow-up: ↓ GM volume of the midbrain (PAG and reticular formation) in responders No significant longitudinal GM volume changes in non-responders | Small sample size of subgroups of responders and non-responders |