In the era of monoclonal antibodies targeting the calcitonin gene-related peptide pathway, is it still necessary to stop taking excessive pain medication?

TL;DR

This paper discusses whether it is still necessary to stop excessive pain medication in the era of new monoclonal antibody treatments for headaches.

Contribution

The paper advocates for individualized headache treatment approaches based on patient-specific factors.

Findings

Different patient groups benefit from different treatment strategies for medication-overuse headache.

Immediate or gradual reduction of pain medication may be appropriate depending on the patient.

Individualized treatment plans are becoming increasingly important as more is learned about the condition.

Abstract

Medication-overuse headache (MOH) was first described in 1951 with ergotamine overuse. Since then, much has been studied about its risk factors, pathophysiology, prevention, and treatment. Despite this, many people still suffer from this condition. Even for those who reach medical care, the path to maintaining significant improvement is neither short nor easy. Here, we propose the ubiquitous individualization of headache treatment. The more we study the condition, the more it becomes evident that different groups of patients benefit from different approaches: starting prophylactic medication immediately or postponing it, providing a bridge treatment or not, and advising patients to either stop medication overuse immediately or reduce it gradually.