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Rigmor Jensen - One of the best experts on this subject based on the ideXlab platform.

  • Medication-Overuse Headache: The effect of a patient educational programme-A randomized controlled trial.
    European journal of pain (London England), 2019
    Co-Authors: Louise Schlosser Mose, Rigmor Jensen, Susanne S. Pedersen, Bibi Gram
    Abstract:

    BACKGROUND Little is known about the effects of non-pharmacological interventions among Medication-Overuse Headache (MOH) patients, although non-pharmacological approaches combined with pharmacological treatment are recommended. The objective was to evaluate the effect of an educational programme as an add-on to standard treatment. METHODS Medication-Overuse Headache patients were randomized (1:1) in a single-centre setting to standard treatment with 12 weeks of education (I-group) versus standard treatment (C-group). The primary outcome was measurement of reduction in Headache days/last month at 9 months' follow-up. Secondary outcomes were Headache intensity, acute Medication intake, bothersomeness, disability, physical activity and patient satisfaction. The between-group differences were analysed using a mixed-effects model for repeated measurements with a between group factor (I-group vs. C-group) and a time factor (baseline, 4 and 9 months). RESULTS Ninety-eight patients were randomized (I-group: n = 48, C-group: n = 50), with 40 and 39 patients completing the study, respectively. Intention-to-treat analyses showed that both groups experienced statistically significant reductions in Headache days/last month (I-group: -4 ± 6 days (95% CI 2.47; 5.95), p 

  • Monitoring chronic Headache and Medication-Overuse Headache prevalence in Denmark
    Cephalalgia : an international journal of headache, 2019
    Co-Authors: Maria Lurenda Westergaard, Cathrine Juel Lau, Karen Allesøe, Signe Thorup Gjendal, Rigmor Jensen
    Abstract:

    ObjectivesTo study chronic Headache and Medication-Overuse Headache (MOH) prevalence; to identify groups with high prevalence of these conditions; and to identify the most frequently used pain medi...

  • complete detoxification is the most effective treatment of Medication Overuse Headache a randomized controlled open label trial
    Cephalalgia, 2018
    Co-Authors: Louise Ninett Carlsen, Rigmor Jensen, Signe Bruun Munksgaard, Lars Bendtsen
    Abstract:

    Background There is lack of evidence on how to detoxify Medication-Overuse Headache. Aim To compare the effect of complete stop of acute Medication with restricted intake. Methods Medication-Overuse Headache patients were included in a prospective, outpatient study and randomized to two months' detoxification with either a) no analgesics or acute migraine-Medication (program A), or b) acute Medication restricted to two days/week (program B). Detoxification was followed by preventives if indicated. Patients were followed up at 2, 6 and 12 months. Percentage reduction in Headache days/month after 6 months was the primary outcome. Results We included 72 Medication-Overuse Headache patients with a primary migraine and/or tension-type Headache diagnosis. Fifty-nine completed detoxification, 58 (81%) were followed up at month 6 and 53 (74%) at month 12. At month 6, program A reduced Headache days/month by 46% (95% CI 34-58) compared with 22% (95% CI 11-34) in program-B ( p = 0.005), and 70% in program A versus 42% in program B were reverted to episodic Headache ( p = 0.04). Migraine-days/month were reduced by 7.2 in program A ( p < 0.001) and 3.6 in program B ( p = 0.002) after 6 months. Conclusion Both detoxification programs were very effective. Detoxification without analgesics or acute migraine-Medication was the most effective program. Trial registration Clinicaltrials.gov (NCT02903329).

  • Clinical presentation and treatment of Medication-Overuse Headache
    Ugeskrift for laeger, 2016
    Co-Authors: Louise Ninett Carlsen, Lars Bendtsen, Signe Bruun Munksgaard, Maria Lurenda Westergaard, Rigmor Jensen
    Abstract:

    Medication-Overuse Headache (MOH) is a disabling, costly and often overlooked disorder. The prevalence in Denmark is 1.8% equivalent to 80.000-100.000 adults. The aim is to increase awareness of clinical presentation and treatment options for patients with MOH when encountered in primary care setting, exemplified by three representative cases. Clinical presentation of MOH and three treatment approaches are discussed. MOH is a chronic disorder which is preventable and treatable.

  • Medication-Overuse Headache: a perspective review:
    Therapeutic advances in drug safety, 2016
    Co-Authors: Maria Lurenda Westergaard, Lars Bendtsen, Signe Bruun Munksgaard, Rigmor Jensen
    Abstract:

    Medication-Overuse Headache (MOH) is a debilitating condition in which frequent and prolonged use of Medication for the acute treatment of pain results in the worsening of the Headache. The purpose of this paper is to review the most recent literature on MOH and discuss future avenues for research. MOH accounts for a substantial share of the global burden of disease. Prevalence is often reported as 1-2% but can be as high as 7% overall, with higher proportions among women and in those with a low socioeconomic position. Management consists of withdrawing pain Medication, focusing on prophylactic and nonmedical treatments, and limiting acute symptomatic Medication. Stress reduction and lifestyle interventions may support the change towards rational pain Medication use. Support, follow up, and education are needed to help patients through the detoxification period. There is fertile ground for research in MOH epidemiology, pathophysiology, and neuroimaging. Randomized and long-term follow-up studies on MOH treatment protocols are needed. Further focused research could be of major importance for global health.

Signe Bruun Munksgaard - One of the best experts on this subject based on the ideXlab platform.

  • Treatment of Medication Overuse Headache—A review
    Acta neurologica Scandinavica, 2019
    Co-Authors: Signe Bruun Munksgaard, Samuel K. Madsen, Troels Wienecke
    Abstract:

    Medication Overuse Headache (MOH) is the most prevalent chronic Headache disorder with a prevalence between 1% and 2% worldwide. The disease has been acknowledged for almost 30 years, yet experts still disagree on how best to treat MOH. By performing a search in PubMed on the terms "Medication Overuse Headache," "analgesics abuse Headache," "rebound Headache," "drug induced Headache," and "Headache AND drug misuse" limited to human studies published in English between January 1, 2004, and November 1, 2017, we aimed to evaluate current literature concerning predictors of treatment outcome, inpatient and outpatient treatment programs, initial versus latent administration of prophylactic Medications, and to review the effect of prophylactic Medications. Selection criteria were prospective, comparative, or controlled trials on treatment of MOH in persons of at least 18 years of age. Several studies evaluated risk factors to predict the outcome of MOH treatment, but many studies were underpowered. Psychiatric comorbidity, high dependence score, and Overuse of barbiturates, benzodiazepines, and opioids predicted a poorer outcome of withdrawal therapy. Patients with these risk factors benefit from inpatient treatment, whereas patients without risk factors benefit equally from inpatient and outpatient treatment. Some Medications for migraine prophylactics have shown better effect on MOH compared with placebo, but not when combined with withdrawal. We conclude that detoxification programs are of great importance in MOH treatment. Latent administration of prophylactic Medications reduces the number of patients needing prophylactic Medication. Individualizing treatment according to the predictors of outcome may improve treatment outcome and thus reduce work-related and treatment-related costs.

  • Economic benefits of treating Medication-Overuse Headache – results from the multicenter COMOESTAS project:
    Cephalalgia : an international journal of headache, 2018
    Co-Authors: Pernille Linde Jellestad, Zaza Katsarava, Signe Bruun Munksgaard, Lars Bendtsen, Maria Lurenda Westergaard, Louise Ninett Carlsen, Miguel J. A. Láinez, Ricardo Fadic, Maria Teresa Goicochea, Santiago Spadafora
    Abstract:

    BackgroundMedication-Overuse Headache is a costly disease for individuals and society.ObjectiveTo estimate the impact of Medication-Overuse Headache treatment on direct and indirect Headache-relate...

  • complete detoxification is the most effective treatment of Medication Overuse Headache a randomized controlled open label trial
    Cephalalgia, 2018
    Co-Authors: Louise Ninett Carlsen, Rigmor Jensen, Signe Bruun Munksgaard, Lars Bendtsen
    Abstract:

    Background There is lack of evidence on how to detoxify Medication-Overuse Headache. Aim To compare the effect of complete stop of acute Medication with restricted intake. Methods Medication-Overuse Headache patients were included in a prospective, outpatient study and randomized to two months' detoxification with either a) no analgesics or acute migraine-Medication (program A), or b) acute Medication restricted to two days/week (program B). Detoxification was followed by preventives if indicated. Patients were followed up at 2, 6 and 12 months. Percentage reduction in Headache days/month after 6 months was the primary outcome. Results We included 72 Medication-Overuse Headache patients with a primary migraine and/or tension-type Headache diagnosis. Fifty-nine completed detoxification, 58 (81%) were followed up at month 6 and 53 (74%) at month 12. At month 6, program A reduced Headache days/month by 46% (95% CI 34-58) compared with 22% (95% CI 11-34) in program-B ( p = 0.005), and 70% in program A versus 42% in program B were reverted to episodic Headache ( p = 0.04). Migraine-days/month were reduced by 7.2 in program A ( p < 0.001) and 3.6 in program B ( p = 0.002) after 6 months. Conclusion Both detoxification programs were very effective. Detoxification without analgesics or acute migraine-Medication was the most effective program. Trial registration Clinicaltrials.gov (NCT02903329).

  • Clinical presentation and treatment of Medication-Overuse Headache
    Ugeskrift for laeger, 2016
    Co-Authors: Louise Ninett Carlsen, Lars Bendtsen, Signe Bruun Munksgaard, Maria Lurenda Westergaard, Rigmor Jensen
    Abstract:

    Medication-Overuse Headache (MOH) is a disabling, costly and often overlooked disorder. The prevalence in Denmark is 1.8% equivalent to 80.000-100.000 adults. The aim is to increase awareness of clinical presentation and treatment options for patients with MOH when encountered in primary care setting, exemplified by three representative cases. Clinical presentation of MOH and three treatment approaches are discussed. MOH is a chronic disorder which is preventable and treatable.

  • Medication-Overuse Headache: a perspective review:
    Therapeutic advances in drug safety, 2016
    Co-Authors: Maria Lurenda Westergaard, Lars Bendtsen, Signe Bruun Munksgaard, Rigmor Jensen
    Abstract:

    Medication-Overuse Headache (MOH) is a debilitating condition in which frequent and prolonged use of Medication for the acute treatment of pain results in the worsening of the Headache. The purpose of this paper is to review the most recent literature on MOH and discuss future avenues for research. MOH accounts for a substantial share of the global burden of disease. Prevalence is often reported as 1-2% but can be as high as 7% overall, with higher proportions among women and in those with a low socioeconomic position. Management consists of withdrawing pain Medication, focusing on prophylactic and nonmedical treatments, and limiting acute symptomatic Medication. Stress reduction and lifestyle interventions may support the change towards rational pain Medication use. Support, follow up, and education are needed to help patients through the detoxification period. There is fertile ground for research in MOH epidemiology, pathophysiology, and neuroimaging. Randomized and long-term follow-up studies on MOH treatment protocols are needed. Further focused research could be of major importance for global health.

Frank Porreca - One of the best experts on this subject based on the ideXlab platform.

  • pathophysiology prevention and treatment of Medication Overuse Headache
    Lancet Neurology, 2019
    Co-Authors: Hans-christoph Diener, Frank Porreca, David William Dodick, Stefan Evers, Dagny Holle, R Jensen, Richard B Lipton, Stephen D Silberstein, Todd J Schwedt
    Abstract:

    Summary Regular or frequent use of analgesics and acute antimigraine drugs can increase the frequency of Headache, and induce the transition from episodic to chronic Headache or Medication Overuse Headache. The 1-year prevalence of this condition in the general population is between 1% and 2%. Medication Overuse Headache is more common in women and in people with comorbid depression, anxiety, and other chronic pain conditions. Treatment of Medication Overuse Headache has three components. First, patients need education and counselling to reduce the intake of Medication for acute Headache attacks. Second, some patients benefit from drug withdrawal (discontinuation of the Overused Medication). Finally, preventive drug therapy and non-medical prevention might be necessary in patients at onset of treatment or in patients who do not respond to the first two steps. The optimal therapeutic approach requires validation in controlled trials.

  • Update on Medication-Overuse Headache
    Current pain and headache reports, 2010
    Co-Authors: Milena De Felice, Michael H Ossipov, Frank Porreca
    Abstract:

    Medication-Overuse Headache (MOH) is a syndrome that can develop in migraineurs after Overuse of antimigraine drugs, including opiates and triptans especially. MOH manifests as increased frequency and intensity of migraine attacks and enhanced sensitivity to stimuli that elicit migraine episodes. Although the mechanisms underlying MOH remain unknown, it is hypothesized that repeated use of antimigraine drugs could elicit increased Headache attacks as a consequence of neuronal plasticity that may increase responsiveness to migraine triggers. Preclinical studies show that exposure to either opiates or triptans can induce pronociceptive neuroadaptive changes in the orofacial division of the trigeminal ganglia that persist even after discontinuation of the drug treatment. Additionally, Medications can elicit increased descending facilitatory influences that may amplify evoked inputs from trigeminal afferents leading to behavioral hypersensitivity reminiscent of cutaneous allodynia observed clinically. Importantly, enhanced descending facilitation may manifest as an inhibition of diffuse noxious inhibitory control. Persistent, pronociceptive adaptations in nociceptors as well as within descending modulatory pathways thus may jointly contribute to the development of MOH.

  • triptan induced latent sensitization a possible basis for Medication Overuse Headache
    Annals of Neurology, 2009
    Co-Authors: Milena De Felice, Ruizhong Wang, Juliana Geremias Chichorro, Ian D Meng, Todd W. Vanderah, Gregory Dussor, Michael H Ossipov, David William Dodick, Frank Porreca
    Abstract:

    Objective Identification of the neural mechanisms underlying Medication Overuse Headache resulting from triptans. Methods Triptans were administered systemically to rats by repeated intermittent injections or by continuous infusion over 6 days. Periorbital and hind paw sensory thresholds were measured to detect cutaneous allodynia. Immunofluorescent histochemistry was employed to detect changes in peptidic neurotransmitter expression in identified dural afferents. Enzyme-linked immunoabsorbent assay was used to measure calcitonin gene-related peptide (CGRP) levels in blood. Results Sustained or repeated administration of triptans to rats elicited time-dependent and reversible cutaneous tactile allodynia that was maintained throughout and transiently after drug delivery. Triptan administration increased labeling for CGRP in identified trigeminal dural afferents that persisted long after discontinuation of triptan exposure. Two weeks after triptan exposure, when sensory thresholds returned to baseline levels, rats showed enhanced cutaneous allodynia and increased CGRP in the blood following challenge with a nitric oxide donor. Triptan treatment thus induces a state of latent sensitization characterized by persistent pronociceptive neural adaptations in dural afferents and enhanced responses to an established trigger of migraine Headache in humans. Interpretation Triptans represent the treatment of choice for moderate and severe migraine Headaches. However, triptan Overuse can lead to an increased frequency of migraine Headache. Overuse of these Medications could induce neural adaptations that result in a state of latent sensitization, which might increase sensitivity to migraine triggers. The latent sensitization could provide a mechanistic basis for the transformation of migraine to Medication Overuse Headache. ANN NEUROL 2010;67:325–337

  • Basic Science: Mechanisms of Medication Overuse Headache
    Headache Currents, 2004
    Co-Authors: Ian D Meng, Frank Porreca
    Abstract:

    Headache caused by Overuse of symptomatic Medications to treat Headache represents a challenging clinical problem. Recent studies exploring both the mechanisms of migraine Headache and neuroplastic changes following sustained exposure to analgesic drugs suggest insights regarding the pathophysiology of Medication Overuse Headache. In this review, changes that occur following chronic morphine that may be particularly relevant to the induction of Medication Overuse Headache will be discussed. Peripherally, these changes include increased expression of calcitonin gene-related peptide (CGRP) in primary afferent neurons. Centrally, they include increased descending facilitation from the rostral ventromedial medulla and increased excitatory neurotransmission at the level of the dorsal horn. Interestingly, many of these same changes, including increased CGRP levels and peripheral and central sensitization, are apparent in inflammatory pain states. Recent revelations into the mechanisms of migraine Headache suggest that neurogenic inflammation leads to both peripheral and central sensitization in the migraine sufferer. Furthermore, CGRP plays a prominent role in initiating vasodilation of the intracranial blood vessels and subsequent Headache. Given the many parallels between the effects of chronic morphine exposure and processes that occur during migraine, it is evident that Overuse of symptomatic Medications to treat Headache could lead to worsening of symptoms. In animals, the neural adaptations that occur after sustained morphine exposure are manifested behaviorally as an increased sensitivity to both tactile and thermal stimulation. In the Headache sufferer, these adaptations could lead to Medication Overuse Headache.

Zaza Katsarava - One of the best experts on this subject based on the ideXlab platform.

  • Economic benefits of treating Medication-Overuse Headache – results from the multicenter COMOESTAS project:
    Cephalalgia : an international journal of headache, 2018
    Co-Authors: Pernille Linde Jellestad, Zaza Katsarava, Signe Bruun Munksgaard, Lars Bendtsen, Maria Lurenda Westergaard, Louise Ninett Carlsen, Miguel J. A. Láinez, Ricardo Fadic, Maria Teresa Goicochea, Santiago Spadafora
    Abstract:

    BackgroundMedication-Overuse Headache is a costly disease for individuals and society.ObjectiveTo estimate the impact of Medication-Overuse Headache treatment on direct and indirect Headache-relate...

  • Medication-Overuse Headache (MOH)
    Pharmacological Management of Headaches, 2016
    Co-Authors: Zaza Katsarava
    Abstract:

    Overuse of any kind of acute Headache/migraine drugs can lead to the development of Medication-Overuse Headache. People suffering from primary Headache such as migraine or tension-type Headache are at higher risk to develop chronic Headache following the Overuse of acute Headache drugs. Treatment of Medication-Overuse Headache requires multidisciplinary setting and includes education of patients, withdrawal as an initial step, and initiation of preventive treatment.

  • Medication Overuse Headache.
    Current neurology and neuroscience reports, 2009
    Co-Authors: Zaza Katsarava, Dagny Holle, Hans-christoph Diener
    Abstract:

    The term Medication Overuse Headache (MOH) was recently introduced by the International Headache Society to describe daily or nearly daily (chronic) Headache that occurs after the regular intake (Overuse) of any kind of antiHeadache or antimigraine drug. Chronic Headache is a growing problem throughout the world. It affects up to 3% to 4% of the general population, and 30% to 50% of such Headaches are attributed to Overuse of antiHeadache drugs. This article reviews the literature on the epidemiology, risk factors, and pathophysiology of MOH. It also summarizes current strategies for treating and preventing Headache chronicity.

  • Prednisone vs. placebo in withdrawal therapy following Medication Overuse Headache
    Cephalalgia : an international journal of headache, 2007
    Co-Authors: L. Pageler, Zaza Katsarava, H. C. Diener, Volker Limmroth
    Abstract:

    This proof-of-concept study evaluated the efficacy of prednisone for the treatment of withdrawal symptoms in patients with Medication Overuse Headache (MOH) in a randomized, placebo-controlled, double-blind design. Twenty patients were randomized and underwent in-patient withdrawal therapy. The total number of hours with severe or moderate Headache within the first 72 and 120 h was significantly lower in the prednisone group. The results show that prednisone might be effective in the treatment of Medication withdrawal Headache.

  • Medication-Overuse Headache: where are we now?
    Current opinion in neurology, 2007
    Co-Authors: Zaza Katsarava, Rigmor Jensen
    Abstract:

    PURPOSE OF REVIEW Many important studies on Medication-Overuse Headache have been published in the last year. Some of them investigated the pathophysiology of Headache chronicity, others focused on evaluation of risk factors. The International Headache Society revised the classification criteria. We provide a summary of the new findings and concepts. RECENT FINDINGS Medication-Overuse Headache was previously defined by the International Headache Society as a chronic Headache which occurs following Overuse of Headache drugs and improves after withdrawal. Hence, the improvement of Headache after withdrawal was mandatory for diagnosis. The new appendix criteria appeared last year and established a broader concept of Medication-Overuse Headache no longer requiring improvement after discontinuation of Medication Overuse. Several large population-based longitudinal studies clearly demonstrated that Overuse of any kind of acute Headache Medication is the main risk factor leading to development of chronic Headache. Imaging studies provided new important insights into the pathophysiology of Headache chronicity. New treatment strategies have been suggested. SUMMARY Recent data provide better insight into pathophysiology of Medication-Overuse Headache. Epidemiological studies clearly demonstrate the necessity of establishing a predictive model for early recognition of patients at high risk to intervene early and avoid development of chronic Headache.

Lars Bendtsen - One of the best experts on this subject based on the ideXlab platform.

  • Economic benefits of treating Medication-Overuse Headache – results from the multicenter COMOESTAS project:
    Cephalalgia : an international journal of headache, 2018
    Co-Authors: Pernille Linde Jellestad, Zaza Katsarava, Signe Bruun Munksgaard, Lars Bendtsen, Maria Lurenda Westergaard, Louise Ninett Carlsen, Miguel J. A. Láinez, Ricardo Fadic, Maria Teresa Goicochea, Santiago Spadafora
    Abstract:

    BackgroundMedication-Overuse Headache is a costly disease for individuals and society.ObjectiveTo estimate the impact of Medication-Overuse Headache treatment on direct and indirect Headache-relate...

  • complete detoxification is the most effective treatment of Medication Overuse Headache a randomized controlled open label trial
    Cephalalgia, 2018
    Co-Authors: Louise Ninett Carlsen, Rigmor Jensen, Signe Bruun Munksgaard, Lars Bendtsen
    Abstract:

    Background There is lack of evidence on how to detoxify Medication-Overuse Headache. Aim To compare the effect of complete stop of acute Medication with restricted intake. Methods Medication-Overuse Headache patients were included in a prospective, outpatient study and randomized to two months' detoxification with either a) no analgesics or acute migraine-Medication (program A), or b) acute Medication restricted to two days/week (program B). Detoxification was followed by preventives if indicated. Patients were followed up at 2, 6 and 12 months. Percentage reduction in Headache days/month after 6 months was the primary outcome. Results We included 72 Medication-Overuse Headache patients with a primary migraine and/or tension-type Headache diagnosis. Fifty-nine completed detoxification, 58 (81%) were followed up at month 6 and 53 (74%) at month 12. At month 6, program A reduced Headache days/month by 46% (95% CI 34-58) compared with 22% (95% CI 11-34) in program-B ( p = 0.005), and 70% in program A versus 42% in program B were reverted to episodic Headache ( p = 0.04). Migraine-days/month were reduced by 7.2 in program A ( p < 0.001) and 3.6 in program B ( p = 0.002) after 6 months. Conclusion Both detoxification programs were very effective. Detoxification without analgesics or acute migraine-Medication was the most effective program. Trial registration Clinicaltrials.gov (NCT02903329).

  • Clinical presentation and treatment of Medication-Overuse Headache
    Ugeskrift for laeger, 2016
    Co-Authors: Louise Ninett Carlsen, Lars Bendtsen, Signe Bruun Munksgaard, Maria Lurenda Westergaard, Rigmor Jensen
    Abstract:

    Medication-Overuse Headache (MOH) is a disabling, costly and often overlooked disorder. The prevalence in Denmark is 1.8% equivalent to 80.000-100.000 adults. The aim is to increase awareness of clinical presentation and treatment options for patients with MOH when encountered in primary care setting, exemplified by three representative cases. Clinical presentation of MOH and three treatment approaches are discussed. MOH is a chronic disorder which is preventable and treatable.

  • Medication-Overuse Headache: a perspective review:
    Therapeutic advances in drug safety, 2016
    Co-Authors: Maria Lurenda Westergaard, Lars Bendtsen, Signe Bruun Munksgaard, Rigmor Jensen
    Abstract:

    Medication-Overuse Headache (MOH) is a debilitating condition in which frequent and prolonged use of Medication for the acute treatment of pain results in the worsening of the Headache. The purpose of this paper is to review the most recent literature on MOH and discuss future avenues for research. MOH accounts for a substantial share of the global burden of disease. Prevalence is often reported as 1-2% but can be as high as 7% overall, with higher proportions among women and in those with a low socioeconomic position. Management consists of withdrawing pain Medication, focusing on prophylactic and nonmedical treatments, and limiting acute symptomatic Medication. Stress reduction and lifestyle interventions may support the change towards rational pain Medication use. Support, follow up, and education are needed to help patients through the detoxification period. There is fertile ground for research in MOH epidemiology, pathophysiology, and neuroimaging. Randomized and long-term follow-up studies on MOH treatment protocols are needed. Further focused research could be of major importance for global health.

  • Reduction of Medication costs after detoxification for Medication-Overuse Headache.
    Headache, 2012
    Co-Authors: Asif M. Shah, Lars Bendtsen, Peter Zeeberg, Rigmor Jensen
    Abstract:

    Objective To examine whether detoxifying patients with Medication-Overuse Headache can reduce long-term Medication costs. Background Direct costs of Medications in Medication-Overuse Headache have been reported to be very high but have never been calculated on the basis of exact register data. Long-term economic savings obtained by detoxification have never been investigated. Methods We conducted a registry-based observational retrospective follow-up study on 336 Medication-Overuse Headache patients treated and discharged from the Danish Headache Center over a 2-year period. By means of the Danish Register of Medicinal Product Statistics, we collected information on the costs and use of prescription-only Medication 1 year before admission and 1 year after discharge from Danish Headache Center. Results The average Medication costs per patient per year decreased with 24%, from US$971 before treatment to US$737 after (P = .001), and the average Medication use decreased with 14.4% (P = .02). Savings were most pronounced for patients overusing triptans. In this group, the average Medication costs per patient per year decreased with 43% (P