The Efficacy Of Low-Dose Amitriptyline Combined With Abrupt Withdrawal In Treatment Of Medication-Overuse Headache

Objective:This study aims to evaluate the long-term efficacy of low-dose amitriptyline combined with abrupt withdrawal in patients with medication-overuse headache (MOH), as well as safety and tolerance.Methods:We evaluated the effectiveness of low-dose amitriptyline combined with abrupt withdrawal in outpatients with MOH over a 1-year observational period. The patients were asked to complete a headache diary during a four-week baseline and every month of follow-up. In the headache diary, patients needed to record their headache frequency, headache intensity, duration and acute medication taking. In the follow-up of month 3 and 12, the number of responders, reduction of headache days, days of taking acute medication and other secondary outcomes were compared with baseline.Results:A total of 39 patients were included in the study.33 patients completed the study with five dropped out of the study, three failed to take the treatment, one lack of efficacy and one lost to follow-up. One patient reported intolerable adverse event (vertigo) and was excluded from the study. Significant reductions in headache frequency and acute medication taking were observed at both month 3 and 12, compared to baseline (P< 0.05 for all). Neither the primary nor the secondary endpoints differed significantly between month 3 and 12. At the month 12,58% of the patients were considered as responders (N=19); 73% remained cured of MOH (N=24); 64% had reverted to episodic headaches (N= 21); 27% had relapsed into MOH (N= 9). The responders were defined as patients with≥50% reduction in headache frequency from baseline and without medication overuse.Conclusion:Low-dose amitriptyline combined with abrupt withdrawal could be considered as a choice for patients with MOH.