# Medication overuse headache: position statement of specialized headache centers in Brazil

## TL;DR

This paper presents expert opinions on managing medication overuse headache in Brazil, highlighting common practices and the need for evidence-based guidelines.

## Contribution

The paper provides a position statement based on expert opinions for MOH management in Brazil, emphasizing current practices and gaps.

## Key findings

- Most experts believe over 50% of migraine patients have MOH and psychiatric comorbidities.
- Experts commonly stop pain medications abruptly and use bridge treatments for over 50% of patients.
- Topiramate and monoclonal antibodies are the top choices for prophylaxis in 36.3% and 54% of cases, respectively.

## Abstract

To develop a position statement based on expert opinions for the management of medication overuse headache (MOH) in Brazil.

This was an observational, prospective, descriptive, and opinion-based study. The experts were in several Brazilian states. Twelve experts who fulfilled the inclusion criteria completed a questionnaire that explored their experiences and approaches to managing MOH in both the private and public sectors.

According to most experts, more than 50% of migraine patients have MOH and psychiatric comorbidities. Experts abruptly stop pain medications, prescribing a bridge treatment for more than 50% of patients. Acute treatment is administered for up to two days per week. Prophylaxis was initiated immediately, and topiramate and monoclonal antibodies were the first choices, respectively, for 36.3% and 54% of professionals. The first follow-up appointment should occur within 4 weeks.

Further guidelines based on evidence as well as expert opinions should be developed for the Brazilian reality, and future prospective studies can be conducted to compare the effects of different treatment regimens for MOH.