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. 2022 Aug 31;23(9):1536-1543.
doi: 10.1093/pm/pnac024.

Natural History of Abortive Medication Withdrawal in the Management of Pediatric Medication Overuse Headache

Emily L Pierce  1 , Alexandra A Mandel  2 , Jeffrey A Strelzik  1 , Raquel L Langdon  1 , William M McClintock  1 , Mark W Cameron  1 , Emily E McCracken  1 , Marc T DiSabella  1
Affiliations

Natural History of Abortive Medication Withdrawal in the Management of Pediatric Medication Overuse Headache

Emily L Pierce et al. Pain Med. .

Abstract

Objective: The objective of this study is to document pain scores during withdrawal of abortive medication in patients diagnosed with medication overuse headache.

Design: Cross-sectional study.

Setting: Children's National Hospital's Headache Program.

Subjects: Patients 6-18 years of age who presented to the Headache Clinic at Children's National Hospital with presumed medication overuse headache between March 2017 and March 2019 were invited to participate.

Methods: Patients were instructed to abruptly discontinue overused medications and record their headache characteristics daily in a diary for 8 weeks.

Results: Fourteen diaries were returned and analyzed at a 4-week follow-up visit. Ninety-three percent of the patients were females, with a median age of 14.9 years (standard deviation [SD] = 2.0). The average headache intensity upon study entry was 4.7 out of 10 (SD = 2.5), and the average headache intensity upon study completion was 3.1 (SD = 2.5). Of the patients, 57% had daily headaches upon study entry, 71% had improved pain intensity from the first diary entry to the last diary entry, and 57% had complete headache resolution at an average of 7.6 days from medication discontinuation (SD = 5.1). Ibuprofen was the most overused medication (71%).

Conclusions: Our findings suggest that medication overuse headache will improve in the majority of pediatric patients who abruptly stop the offending medication(s) in an average of 8 days from withdrawal. Average pain intensity was reduced by more than one point among all patients who stopped taking abortive medications. Further larger-scale studies on medication withdrawal in pediatric patients with medication overuse headache could help us better understand whether this management strategy is effective.

Keywords: Abortive Medication; Chronic Headache; Medication Overuse Headache; Medication Withdrawal Therapy; Pediatrics; Rebound Headache.

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