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. 2020 Aug 19:11:823.
doi: 10.3389/fneur.2020.00823. eCollection 2020.

Medication Overuse Withdrawal in Children and Adolescents Does Not Always Improve Headache: A Cross-Sectional Study

Romina Moavero  1   2 , Maddalena Stornelli  2 , Laura Papetti  1 , Fabiana Ursitti  1 , Michela Ada Noris Ferilli  1 , Martina Balestri  1 , Giorgia Sforza  2 , Samuela Tarantino  1 , Federico Vigevano  1 , Massimiliano Valeriani  1   3
Affiliations

Medication Overuse Withdrawal in Children and Adolescents Does Not Always Improve Headache: A Cross-Sectional Study

Romina Moavero et al. Front Neurol. .

Abstract

Background: MOH can be diagnosed in subjects with headache occurring 15 days/month in association with a regular medication overuse, but its existence is not universally accepted. ICHD-3 redefined criteria for MOH, removing the criterion associating drug suspension with headache course. The aim of our study was to compare the rate of patients diagnosed with medication overuse headache (MOH) according to ICHD-2 and ICHD-3 criteria, to verify the degree of concordance. The secondary aim was to verify if drug withdrawal was really associated with pain relief. Methods: In this cross-sectional study, we retrospectively analyzed a sample of 400 patients followed for primary chronic headache at the Headache Center of Bambino Gesù Children's Hospital. We then selected those presenting with a history of medication overuse, and we applied both ICHD-2 and ICHD-3 criteria to verify in which patients the criteria would identify a clinical diagnosis of MOH. Results: We identified 42 subjects (10.5%) with MOH; 23 of them (55%) presented a relief of headache withdrawing drug overuse. Regarding the applicability of the ICHD-2 criteria, 43% of patients (18/42) fulfilled all criteria, while all ICHD-3 diagnostic criteria were satisfied in 76% of patients (32/42). Eighteen patients (43%) satisfied both ICHD-2 and ICHD-3 criteria, while 10 patients (24%) did not satisfy either diagnostic criterion. Conclusions: Our study suggests that in children and adolescents, withdrawing medication overuse is not always associated with a clinical benefit. Therefore, though allowing a MOH diagnosis in a higher rate of patients as compared to ICHD-2, the application of ICHD-3 criteria does not guarantee a true a causal relationship between medication overuse and headache worsening.

Keywords: ICHD-3 criteria; children; chronic migraine; medication overuse headache; secondary headache; treatment.

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Figures

Figure 1
Figure 1
Flowchart showing patients' disposition.
Figure 2
Figure 2
Different diagnostic rate of Medication Overuse Headache according to ICHD-2 criteria (A) vs. ICHD-3 criteria (B).
Figure 3
Figure 3
Applicability of ICHD-2 (A) and ICHD-3 (B) diagnostic criteria for MOH.
See this image and copyright information in PMC

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