Dr Rigmor Jensen Explains the Debate Around Medication Overuse Headache

Medication overuse headache is a peculiar disorder where the cure becomes the cause, said Rigmor Jensen, MD, professor of neurology at The University of Copenhagen and director of the Danish Headache Center.

Transcript:

The American Journal of Managed Care® (AJMC®): Can you give a brief overview of your work?

Dr. Jensen: My name is Rigmor Jensen. I'm a professor of neurology at The University of Copenhagen. I'm director of the Danish Headache Center and it's multidisciplinary center that takes care of difficult to treat headache patients. It's a National Center of Excellence, so we see patients from all over the country, and we see difficult patients and we have a lot of research. Part of the time is research, clinical trials, experimental studies, then we have a part time clinic.

AJMC®: What are the arguments on each side of the debate on medication overuse headache?

Dr. Jensen: Medication overuse is a peculiar disorder, where the cure becomes the cause, in many, many cases. Patients, especially migraine patients, that are insufficiently treated, they have never tried preventive drugs. Then they take more and more of the acute drugs and end up with a chronic, very difficult to treat type of headache. There are migraine attacks in between, but there's a background headache all the time. So the debate that has been ongoing for years now is what is the hen and what is the egg here? Is it because the migraine is not properly treated and we should keep them preventives and treat that? Or should we look at the medication use as a significant trigger for the headache? So where to start in this vicious circle? Because it's vicious, they become more, more refractory to everything. How can we avoid this significant chronification?The debate is should we take the offending drug away first and then give them preventives? Or should we give them preventives and then see what happens over time when we try to give proper preventives and then the drug consumption will go down. That's the issue that has been ongoing for many years.

Our policy here, is that we take the offending drug away, the overuse first, because it's not good for your system to take all those drugs. We see that we can reduce the headache frequency by 75% when we take the drug away. The problem is, that it is not easy for the patient to take the acute drugs away. This is difficult to handle, and they're scared, especially if they take a lot and have for many years, because they can have such a rebound headache. So there's this debate and some patients are afraid of it. But what we have demonstrated now with our studies is that it's actually easier to stop totally with drugs than just taper down. It is also more effective to take preventives and withdrawal at the same time, compared to just taking the drug away first, and then wait and see, and then put them on preventives after some months. In a recent study we have done that- with preventive and withdrawal of the medication. That's the most effective way.