Therapeutic target
Relief of withdrawal symptoms.
Therapy recommendations
- If educating the patient alone does not lead to cessation of medication overuse, medication interruption or withdrawal treatment is required.
- Medication interruption or withdrawal (sometimes only for 2 to 4 weeks) can break a medication overuse headache in most patients.The term medication interruption refers to the fact that after a successful interruption, the headache frequency remits again below 10 days per month: The acute medication can then be used again.
- Symptomatic therapy:
- Nausea: domperidone (dopamine antagonist) or dimenhydrinate (antihistamine; Cave!! Dimenhydrinate itself has a potential for dependence).
- Withdrawal headache: acetylsalicylic acid, naproxen (nonsteroidal anti-inflammatory drugs, NSAIDs); indication only if no prior abuse of a non-opioid analgesic!No indication for opioids, triptans or secalealkaloids!Note: The use of analgesics such as naproxen during drug withdrawal, whether for acute treatment of severe (withdrawal) headache, whether for prophylaxis of the same – should be avoided.
- If necessary, prophylaxis of the primary headache must be performed.
- In individual cases, prednisone (glucocorticoids) prophylactic – especially in the first days of drug withdrawal – can often prevent the occurrence of more severe headaches.
- Permanent limitation of acute medication: after successful drug withdrawal, the intake limits for headache acute medication (max. 10 days / month for triptans, ergotamines, opioids and / or mixed analgesics or max. 15 days / month for monoanalgesics) are to be observed in the long run
- See also under “Further therapy“.
