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Abstract Details

Acute Migraine Medication and Medication Overuse Headache: A Systematic Literature Review
Headache Posters (7:00 AM-5:00 PM)

Frequent use of acute medications for migraine is associated with a disabling secondary disorder, MOH; affecting 30% of patients with migraines at specialty clinics. Literature to characterize the burden of MOH is limited; and a formal synthesis is lacking.

To synthesize global data characterizing the burden of medication overuse headache (MOH).

A systematic literature review, conducted using MEDLINE and EMBASE using PICOS criteria, identified articles characterizing the burden associated with acute treatments for migraine. Outcomes among subjects with MOH were summarized: 1) percentage overusing acute medications by class; 2) percentage with unsuccessful withdrawal (inability to discontinue the overused medication); and 3) factors associated with unsuccessful withdrawal.

From 5,770 records identified, 743 full-text articles were screened; 15 studies were included that reported on outcomes among subjects with MOH. Data were identified from North America, Europe, Asia, and South America; and most studies identified subjects through medical records using ICHD criteria. Among those with MOH, the percentage overusing triptans varied from 0% to 46%, combination analgesics 17%-71%, opioids 0%-48%, and ergots 2%-43%; opioid (48%) and triptan (16%) use was common among North American subjects attending an inpatient withdrawal program. The rate of unsuccessful withdrawal at 1-year ranged from 21%-40%. Unsuccessful withdrawal was associated with the presence of mood disorders and anxiety, duration of MOH, medication type, greater migraine-related disability, and frequency. Data were largely available from inpatient programs, which may reflect a more severe patient population.

These data characterize the burden of MOH and demonstrate an unmet need for acute treatments that do not confer a risk of MOH. Further research using real-world data from a large representative sample of adults with migraine who develop MOH is needed to characterize the clinical, humanistic, and economic burden of MOH among subjects using acute treatment for migraine.

Alison Deighton
Alison Deighton has nothing to disclose.
Karissa Johnston Karissa Johnston has nothing to disclose.
Diego Fernandez-Vial (University of Kentucky) Linda Harris has received personal compensation for serving as an employee of Biohaven Pharmaceuticals. Linda Harris has received stock or an ownership interest from Biohaven Pharmaceuticals.
Gilbert J. L'Italien Gilbert J. L'Italien has received personal compensation for serving as an employee of Biohaven Pharmaceuticals. Gilbert J. L'Italien has stock in biohaven pharmaceuticals.