Search

Acute withdrawal of headache medication in chronic migraine patients with medication overuse may lead to a dramatic reduction in headache frequency and severity. However, the brain networks underlying chronic migraine and a favorable response to acute withdrawal are still poorly understood. The goal of the present study was to characterize the pattern of intrinsic magnetic resonance imaging (MRI) functional connectivity (FC) specific to chronic migraine and to identify changes in FC that characterize subjects with CM reverting to less frequent headaches. Subjects with chronic migraine (N = 99) underwent a resting-state functional MRI scan before and after three months of medication withdrawal therapy. In addition, we included four control groups who were scanned once: healthy participants (N = 27), patients with episodic migraine (N = 25), patients with chronic back pain (N = 22), and patients with clinical depression (N = 17). Using dual regression analysis, we compared whole-brain voxel-level functional connectivity with ten well-known resting-state networks between chronic migraine and control groups, and between responders to treatment (≥50 % reduction in monthly headache days) and non-responders (

Apart from specific groups of users (e.g., MSM, sexually traumatized users) and phenomena of appearance (e.g., chemsex), the theoretical discussion of sexuality and partnership among people with substance-related addiction disorders must be considered insufficient. This has consequences for the clinical practice of inpatient withdrawal therapy, where there is usually a blankspace in this respect. This paper is a plea for a conceptual expansion of the clinical setting; it demonstrates the necessity of including and considering the sexuality of patients and traces possible conditions of the existing voids. As a starting point, the first descriptive findings of a survey of patients with a substance-related addiction disorder (n=70) are presented and discussed. [ABSTRACT FROM AUTHOR]

Background and purpose: Medication overuse headache is a prevalent disorder, with a strong biobehavioural component. Hence, behavioural interventions might effectuate reduction of the overused medication. We assessed in a double‐blind manner the efficacy of a behavioural intervention during medication withdrawal therapy. Methods: In this concealed, double‐blind, randomized controlled trial in medication overuse headache, conducted at the Leiden University Medical Centre, we compared the effect of maximal versus minimal behavioural intervention by a headache nurse during withdrawal therapy. Maximal intervention consisted of an intensive contact schedule, comprising education, motivational interviewing, and value‐based activity planning during 12 weeks of withdrawal therapy. Minimal intervention consisted of a short contact only. Patients were unaware of the existence of these treatment arms, as the trial was concealed in another trial investigating botulinum toxin A. Endpoints were successful withdrawal and monthly days of acute medication use after the withdrawal period. Results: We enrolled 179 patients (90 maximal, 89 minimal intervention). At Week 12, most patients achieved withdrawal in both groups (82/90 [93%] maximal intervention vs. 75/89 [86%] minimal intervention, odds ratio = 2.44, 95% confidence interval [CI] = 0.83–7.23, p = 0.107). At Week 24, patients in the maximal intervention group had fewer medication days (mean difference = −2.23, 95% CI = −3.76 to −0.70, p = 0.005). This difference receded over time. Change in monthly migraine days did not differ between groups (−6.75 vs. −6.22). Conclusions: This trial suggests modest benefit of behavioural intervention by a headache nurse during withdrawal therapy for medication overuse headache, to reduce acute medication use during and shortly after intervention, but extension seems warranted for a prolonged effect [ABSTRACT FROM AUTHOR]

To manage patients with drug-induced headache (DIH) is an unsolved problem of modern neurology in developed countries, since DIH is becoming a common cause of temporary disability and leads to lower quality of life in patients. Patients with primary headache (for example, those with tension headache or migraine) frequently take symptomatic headache relief medications uncontrollably, which can result in the higher frequency and intensity of DIH episodes. In turn, new headache attacks make the patients take the increasing number of symptomatic medications, which leads to the development of DIH.The International Classification of Headache Disorders, 3 rd Edition, defines DIH as a distinct form of secondary headache. To date, there is no consensus on the tactics of DIH treatment and prevention. The paper discusses different approaches to DIH prevention and treatment, the effectiveness and appropriateness of their use, as well as factors influencing illness course and possible outcomes. Particular attention is paid to the management of patients during the withdrawal period, risk factors for DIH recurrences, and ways of their prevention.

The objective of this meta-analysis was to evaluate the therapeutic effectiveness of prednisone in withdrawal therapy following medication overuse headache. The Cochrane, PubMed, EMBASE, Web of Science, CNKI, VIP, and Wanfang data were searched to identify randomized control trials of prednisone for the treatment of medication overuse headache. Two researchers independently screened published studies according to inclusion and exclusion criteria, and evaluated the methodological quality of included studies. Revman 5.3 software was used to analyze the extracted data, and a total of six randomized control trials involving 510 patients were included in the study. Meta-analysis indicated that there was no significant difference in the ratio of taking painkillers again after withdrawal (RR=0.89, 95% CI: 0.70,1.14, P=0.36) compared with the control group. There was also no significant difference between the experimental group and the control group in the incidence of withdrawal reactions (RR=1.28, 95% CI: 0.87, 1.89, P=0.21), severity of headache (RR=1.56, 95% CI: -4.83, 7.95, P=0. 63) and the frequency of headache attacks after withdrawal (RR=0.14, 95% CI: -0.35, 0.63, P=0.58). It is concluded that prednisone does not alleviate symptoms in patients with medication overuse headache after withdrawal. [ABSTRACT FROM AUTHOR]

Copyright of Mezdunarodnyj Nevrologiceskij Zurnal is the property of Zaslavsky O.Yu and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The most severe consequences of drug abuse include infectious diseases, overdoses, and drug-related deaths. As the range of toxicologically relevant compounds is continually changing due to the emergence of new psychoactive substances (NPS), laboratories are encountering analytical challenges. Current immunoassays are insufficient for determining the whole range of the drugs abused, and a broad-spectrum screening method is therefore needed. Here, the patterns of drug abuse in two groups of drug users were studied from urine samples using a comprehensive screening method based on high-resolution time-of-flight mass spectrometry. The two groups comprised drug abusers undergoing opioid maintenance treatment (OMT) or drug withdrawal therapy and routinely visiting a rehabilitation clinic, and drug abusers with irregular attendance at a harm reduction unit (HRU) and suspected of potential NPS abuse. Polydrug abuse was observed in both groups, but was more pronounced among the HRU subjects with a mean number of concurrent drugs per sample of 3.9, whereas among the regularly treated subjects the corresponding number was 2.1. NPS and pregabalin were more frequent among HRU subjects, and their abuse was always related to drug co-use. The most common drug combination for an HRU subject included amphetamine, cannabis, buprenorphine, benzodiazepine, and alpha-pyrrolidinovalerophenone. A typical set of drugs for treated subjects was buprenorphine, benzodiazepine, and occasionally amphetamine. Abuse of several concurrent drugs poses a higher risk of drug intoxication and a threat of premature termination of OMT. Since the subjects attending treatment used fewer concurrent drugs, this treatment could be valuable in reducing polydrug abuse. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: The purpose was to compare the effectiveness and safety of calcineurin inhibitors (CNIs) withdrawal and continued therapies in kidney transplant recipients. Methods: We searched the PubMed, MEDLINE, Springer, Elsevier Science Direct, Cochrane Library and Google Scholar up to May 2014. Risk ratio (RR) or weighted mean difference (WMD) and their 95 % confidence intervals (CIs) were calculated in fixed-effects model or random-effects model when appropriate. Besides, sensitivity analysis was performed based on the addition of sirolimus in initial immunosuppression protocols. Results: Total seven studies with 1071 kidney transplant recipients received CNIs withdrawal therapy (experimental group) and 792 kidney transplant recipients received CNIs continued therapy (control group) were included in the meta-analysis. The overall estimates of acute rejection rate (RR = 1.64, 95 % CI: 1.19-2.27, P = 0.003), mean measured glomerular filtration rate (WMD = 9.50, 95 % CI = 2.96-16.03, P = 0.004), thrombocytopenia (RR = 3.39, 95 % CI: 2.27-5.05, P < 0.00001) and hypertension (RR = 0.56, 95 % CI: 0.40-0.78, P = 0.0006) showed that there were significant differences between the CNIs withdrawal and continued therapies in kidney transplant recipients, while no significant differences were found between groups in survival rate, graft survival rate, diabetes, hypercholesterolemia, hypertriglyceridemia and malignancies. In addition, two studies, in which sirolimus was not used in initial immunosuppression protocol, were excluded in sensitivity analysis and the results were still consistent with the overall analysis. Conclusions: CNIs withdrawal therapy in kidney transplant recipients could significantly decrease risk of hypertension and improve glomerular filtration rate, accompanying with increased risk of acute rejection and thrombocytopenia, compared with the CNIs continued therapy. [ABSTRACT FROM AUTHOR]

Background: Medication overuse headache is a common condition with a population-based prevalence of more than 1-2%. Treatment is based on education, withdrawal treatment (detoxification), and prophylactic treatment. It also includes management of withdrawal headache. Aims: This guideline aims to give treatment recommendations for this headache. Materials and methods: Evaluation of the scientific literature. Results: Abrupt withdrawal or tapering down of overused medication is recommended, the type of withdrawal therapy is probably not relevant for the outcome of the patient. However, inpatient withdrawal therapy is recommended for patients overusing opioids, benzodiazepine, or barbiturates. It is further recommended to start individualized prophylactic drug treatment at the first day of withdrawal therapy or even before. The only drug with moderate evidence for the prophylactic treatment in patients with chronic migraine and medication overuse is topiramate up to 200 mg. Corticosteroids (at least 60 mg prednisone or prednisolone) and amitriptyline (up to 50 mg) are possibly effective in the treatment of withdrawal symptoms. Patients after withdrawal therapy should be followed up regularly to prevent relapse of medication overuse. Discussion and conclusion: Medication overuse headache can be treated according to evidence-based recommendations. [ABSTRACT FROM AUTHOR]

Abstract: Discontinuation of medication is the treatment of choice for patients with chronic daily headache (CDH) who overuse their medications. This treatment may be difficult due to increased headache severity observed in patients immediately after withdrawal. We retrospectively evaluated the efficacy of valproic acid therapy in 66 patients with overuse of CDH medication during withdrawal therapy. Patients were all withdrawn from medications and valproic acid started at 250mg or 500mg daily. Forty-two (63.6%) patients had decreased headache severity, including 27.3% objective responses in the first week. At the last visit in the 12th week, 50 patients were headache-free and only one patient had persistent headache. Fifteen patients withdrew from therapy due to side effects and lost to follow-up within this timeframe. Thus, low dose valproic acid appears to be safe and effective in the management of withdrawal therapy. [Copyright &y& Elsevier]

One hundred and one patients suffering from chronic daily headache (CDH) and medication overuse were treated, in an in-patient setting, with abrupt discontinuation of the medication overused, intravenous hydrating, and intravenous administration of benzodiazepines and ademetionine. The mean time to CDH resolution was 8.8 days. The in-patient withdrawal protocol used was effective, safe and well tolerated. There was a trend for a shorter time to CDH resolution in patients who overused triptans ( P = 0.062). There was no correlation between time to CDH resolution and either the type of initial primary headache or duration of medication abuse, whereas time to CDH resolution was related to daily drug intake ( P = 0.01). In multiple regression analysis, daily drug intake, age and type of medication overused were independent predictors of time to CDH resolution. At 3-months’ follow-up, no patient had relapsed and was again overusing symptomatic medications. [ABSTRACT FROM AUTHOR]

Patients suffering from migraine, tension-type headache (TTH), or combined headache (CH) are at risk of developing drug-induced headache (DIH) due to regular use of analgesics, ergot alkaloids, and triptans. The aim of our study was to determine (1) the clinical features of DIH, (2) the outcome of withdrawal therapy using high methodological standards, and (3) predictors which could explain the high relapse rate (more than 40%) after a previously successful withdrawal therapy. We retrospectively reviewed 103 patients with migraine or TTH who underwent withdrawal therapy between 1994 and 1998. The long-term follow-up (2–4 years after therapy) was conducted by phone and by specially trained psychologists using a structured interview which enclosed characteristics of headache and medication behavior as well as patients global assessment of success. Complete sets of data were available from 83 patients (38 migraine, 26 TTH, 19 CH). The most frequently abused drugs were caffeine-combined analgesics (24%), followed by caffeine-combined ergotamines (19%), pure ergot alkaloids (17%), and monoanalgesics (17%). 48.5% of the patients suffered an abuse relapse within 4 years and developed the complete features of DIH again. Analgesic and ergot alkaloid combinations with caffeine lead significantly more often to a relapse. A long-term successful therapy is connected with a significant reduction of the frequency of headache attacks. Under relapse conditions, the patients reached their former headache frequency level. The data show a higher relapse rate than previously assumed and that certain substance groups bear a higher relapse risk.Copyright © 2001 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Chronic daily headache (CDH) associated with long-term misuse of headache medication is a common clinical problem which is refractory to most treatments. The present study is a retrospective analysis of the effect of drug withdrawal therapy in patients with CDH and frequent long-term use of headache symptomatic medication. One hundred and one adult patients (74 women and 27 men, aged between 16 and 72 years, mean age 43 years) were evaluated 1-3 months after drug withdrawal therapy had been initiated. The mean headache frequency at baseline was 26.9+/-4.0 days per month. Fifty-seven (56%) patients were significantly improved (defined as at least 50% reduction in number of headache days) after a period of drug withdrawal therapy. Based on the outcome of the drug withdrawal therapy, the patients were divided into three categories: group I, those who had between 0 and 10 headache days per month (n = 41), group II, those who had 11-20 days (n = 37), and group III, those who had 21-30 days (n = 23). The mean headache frequencies in groups I, II and III were 5.6+/-2.8 days, 15.7+/-2.5 days and 28.7+/-2.4 days, respectively. Treatment with amitriptyline was offered to patients in whom no improvement had been achieved. Ten of those 22 patients (36%) experienced a significant (> or = 50%) reduction of headache days. It is concluded that out-patient drug withdrawal therapy is the treatment of choice in patients with CDH and frequent long-term use of headache symptomatic medication, and that about one quarter of these CDH patients do not respond to drug withdrawal therapy only. [ABSTRACT FROM AUTHOR]

Drug-induced headache is a well-known complication of the treatment of primary headache disorders, and its successful management is only possible by withdrawal therapy. However, it is unknown whether ambulatory or stationary withdrawal is the therapy preferred. We conducted a prospective study on the outcome of stationary versus ambulatory withdrawal therapy in patients with drug-induced headache according to the International Headache Society criteria. Out of 257 patients with the diagnosis of drug-induced headache during the study period, 101 patients (41 after ambulatory and 60 after stationary withdrawal therapy) could be followed up for 5.9 +/- 4.0 years. The total relapse rate after successful withdrawal therapy was 20.8% (14.6% after ambulatory and 25.0% after stationary withdrawal therapy, p < 0.2). The main risk factors for a relapse were male sex (OR = 3.9, CI = 1.3-11.6), intake of combined analgesic drugs (OR = 3.8, CI = 1.4-10.3), administration of naturopathy (OR = 6.0, CI = 1.2-29.3), and a trend to tension-type headache as the primary headache disorder (OR = 1.9, CI = 0.6-53.0). Our data suggest that neither the method of withdrawal therapy nor the kind of analgesic and other antimigraine drugs has a major impact on the long-term result after successful withdrawal therapy. Patients with risk factors according to our findings should be informed and monitored regularly, and combined drugs should be avoided. Furthermore, our data suggest that there is a need for research on individual psychological and behavioral risk factors for relapse after successful withdrawal therapy in drug-induced headache. [ABSTRACT FROM AUTHOR]

Headache characteristics are described in 139 patients with chronic daily or almost daily headaches due to regular intake of analgesics and the short- and long-term results of drug withdrawal. Drug-induced headache was described as dull, diffuse, and band-like, and usually started in the early morning. The mean duration of the original headache (migraine or tension headache) was 25 years; regular intake of drugs and chronic daily headache had started 10 and 6 years prior to withdrawal therapy, respectively. Patients took an average of 34.6 tablets or analgesic suppositories or antimigraine drugs per week containing 5.8 different substances. The drugs most often used were caffeine (95%), ergotalkaloids (89%), barbiturates (64%), and spasmolytics, paracetamol, and pyrazolone derivates (45%-46%). A total of 103 patients (68 migraine, 35 tension or combination headache) were available for interviews at a mean time interval of 2.9 years after an inpatient drug withdrawal programme. Chronic headache had disappeared or was reduced by more than 50% in two-thirds of the patients. Positive predictors for successful treatment were migraine as primary headache, chronic headache lasting less than 10 years, and regular intake of ergotamine. Drug intake was significantly reduced and patients used single substances more often. Patients who originally suffered from migraine, superimposed on the daily headache, also experienced a significant improvement in the frequency of the migraines and their intensity. Migraine prophylaxis through beta-blocking agents and calcium channel antagonists was more efficient after drug-withdrawal therapy. [ABSTRACT FROM AUTHOR]

Management of patients affected by chronic daily headache (CDH) with medication overuse constitutes one of the most important unresolved problems. The uncertainty regarding the classification and the prophylaxis are a remarkable part of this problem. Objectives are to: (1) to evaluate the efficacy of withdrawal therapy following prophylaxis with topiramate and amitriptyline in a population affected by CDH and medication overuse with follow-up at 1 (T1), 3 (T2) and 6 (T3) months; (2) to identify which group of the Silberstein’s CDH classification (1994) may benefit from this protocol. Inclusion criteria are patients with CDH (headache for more >15 days/month for at least 3 consecutive months) and medication overuse according with IHS second edition (8.2 group); exclusion criteria are patients with secondary headache. All patients included in the study were hospitalized for 1 week. Type of overuse: combination of medications, 38%; analgesics, 29%; triptans, 29%; opioids, 2%; ergotamines, 2%. During hospitalization the following protocol was applied: desametasone 4 mg i.v./day for 1 week, diazepam 6 mg/day for 10 days and prophylaxis with amitriptylin plus topiramate. This prophylaxis was protracted for at least 6 months. The dosages assumed ranged for amitriptylin from 10 to 20 mg/day and for topiramate from 50 to 100 mg/day. In the last 4 years 105 patients with CDH (age 24–89 years; f 96; m 9) were admitted to the hospital. The protocol was applied in 52 patients (age, 29–65 years; f 49; m 3). At T1, 89% of the patients did not fall again into medication overuse; at T2, 64%; and at T3,45% of the patients remained free from overuse. According to the Silberstein’ proposal at T1, 93% of the subjects was affected by transformed migraine; and 7% by tension-type headache. At T3, all the patients free from overuse were affected by transformed migraine. Our data suggest that the patients affected by CDH and medication overuse benefit from withdrawal therapy performed during hospitalization plus prophylaxis with amitriptyline plus topiramate. This combination seems a good pharmacological solution to reduce the risk of relapse. [ABSTRACT FROM AUTHOR]

Objective: To observe the therapeutic effect of compound decoction of Comcide (CDC), a traditional Chinese medicine (TCM) in treating the withdrawal reaction (WR) of heroin dependent rhesuses (HDR). Methods: To study therapeutic effects of CDC and methadone in treating WR of HDR models induced by administering of heroin. Through observing, comparing and evaluating the scores of all groups gained during the first 4 days when the WR was most severe. Results: CDC and methadone had the same therapeutic effects on WR of HDR. There were significant differences between the scores of CDC and methadone, and that of natural withdrawal, P < 0. 01; while there were insignificant difference between the scores of CDC and that of methadone, P > 0.05. Conclusion: CDC had the therapeutic effect in treating WR of HDR. [ABSTRACT FROM AUTHOR]