{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T18:38:03Z","timestamp":1785609483944,"version":"3.56.0"},"reference-count":26,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2019,3,15]],"date-time":"2019-03-15T00:00:00Z","timestamp":1552608000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Complete stop of acute medication and\/or migraine medication for treatment of medication\u2010overuse headache (MOH) has previously been reported more effective in reducing headache days and migraine days per month compared with restricted intake of acute medication. However, it is unknown whether complete stop or restricted intake is the most feasible treatment for patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate whether feasibility of withdrawal in MOH is different between complete stop of acute medication and restricted intake, and whether reductions in headache\u2010related medication dependence, anxiety and depression differ between the treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Medication\u2010overuse headache patients were included in a prospective, open\u2010label, outpatient study and randomized to two months of withdrawal with either no analgesics or acute migraine medication (programme A) or acute medication restricted to 2\u00a0days\/week (programme B). After 6 and 12\u00a0months, patients graded feasibility of withdrawal. Dependence was measured by Severity of Dependence Scale (SDS), while anxiety and depression were measured by Hospital Anxiety and Depression Scale (HADS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We included 72 MOH patients with primary migraine and\/or tension\u2010type headache. Forty\u2010nine completed withdrawal and the SDS questionnaire at 12\u2010month follow\u2010up, and the feasibility of withdrawal was significantly higher in programme A compared to programme B (<jats:italic>p\u00a0&lt;\u00a0<\/jats:italic>0.001). At 12\u00a0months, the dependence was reduced by 44% in programme A compared to 26% in programme B (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.053), while the anxiety score was reduced by 32% and 11%, respectively (<jats:italic>p<\/jats:italic>\u00a0=\u00a00.048).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Withdrawal with complete stop of acute medication was more feasible and most effective in reducing headache\u2010related anxiety compared with restricted intake.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>A <jats:bold>c<\/jats:bold>omplete stop of all analgesics is the most effective treatment for MOH regarding reduction in headache days but has often been regarded as too challenging for patients. However, in this study, complete stop appears to be more feasible compared with restricted intake of analgesics seen from the patients\u2019 perspective.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.1383","type":"journal-article","created":{"date-parts":[[2019,2,22]],"date-time":"2019-02-22T07:00:37Z","timestamp":1550818837000},"page":"1162-1170","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":34,"title":["Complete withdrawal is the most feasible treatment for medication\u2010overuse headache: A randomized controlled open\u2010label trial"],"prefix":"10.1002","volume":"23","author":[{"given":"Ida Maria Storm","family":"Engelstoft","sequence":"first","affiliation":[{"name":"Danish Headache Center Rigshospitalet Glostrup Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise Ninett","family":"Carlsen","sequence":"additional","affiliation":[{"name":"Danish Headache Center Rigshospitalet Glostrup Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Signe Bruun","family":"Munksgaard","sequence":"additional","affiliation":[{"name":"Danish Headache Center Rigshospitalet Glostrup Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mia","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Danish Headache Center Rigshospitalet Glostrup Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rigmor H\u00f8jland","family":"Jensen","sequence":"additional","affiliation":[{"name":"Danish Headache Center Rigshospitalet Glostrup Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Bendtsen","sequence":"additional","affiliation":[{"name":"Danish Headache Center Rigshospitalet Glostrup Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03070.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102413515338"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3999(01)00296-3"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2009.02571.x"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102417737779"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1348\/014466501163904"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2016.124"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2011.03497.x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2005.09.034"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-2982.2008.01712.x"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1360-0443.1995.9056072.x"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2008.168864"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10194-010-0285-1"},{"key":"e_1_2_9_15_1","first-page":"1162","article-title":"Headache classification committee of the international headache society (IHS) the international classification of headache disorders","volume":"38","author":"IHS","year":"2018","journal-title":"Cephalalgia: An International Journal of Headache"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ene.12850"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1186\/s10194-016-0649-2"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2011.12.008"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102412475235"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2007.00999.x"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0333102414521508"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2010.01631.x"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10194-012-0469-y"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-015-1858-3"},{"key":"e_1_2_9_25_1","unstructured":"WHO(2017).Severity of Dependence Scale (SDS). 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