Stopping Medication Overuse Can Halt Transformed Migraine

by Teri Robert, MyMigraineConnection Lead Expert

Data from a study released in Headache: The Journal of Head and Face Pain, confirms once again a major point we've discussed about transformed Migraine. When medications that are being overused and leading to medication overuse headaches are discontinued, there is significant improvement in headache frequency, and transformed Migraine reverts back to episodic Migraine without chronic daily headache.

Study objective

To identify the factors contributing to the reversion of transformed Migraine (TM) into episodic Migraine.

Study method

  • 145 of 1,142 consecutive headache patients seen at the Headache Clinic of the Samsung Medical Center met the criteria for diagnosis of transformed Migraine, and their progress was followed for at least one year.
  • At initial assessment, data was collected on
    • headache profile based on International Headache Society diagnostic criteria
    • medical history including information regarding medication overuse, chronic use of analgesics for other conditions, coexisting chronic illnesses, caffeine consumption in excess of 100mg daily, alcohol consumption, smoking, family medical history
    • lifestyle details including exercise
  • Management protocol:
    • abrupt discontinuation of overused medications
    • compliance with preventive regimen
    • lifestyle modifications including regular exercise, elimination of caffeine and alcohol, smoking cessation

Study results

  • 136 of the initial 145 patients finished the the study through final follow-up assessment 1 year after the initial evaluation.
  • Five patients were lost to follow-up and 4 patients refused the follow-up interview.
  • Of the 136 patients:
    • 122 were women.
    • In 95 (70%) patients, their transformed Migraines converted to episodic Migraine
    • 41 (30%) continued to suffer daily headaches without a period of improvement
    • 10 did not discontinue overused drugs. None of them improved to episodic Migraine
  • The 2 major reasons for poor compliance with preventive medication regimens were side effects and
    low efficacy
  • Significant positive factors in reversion of transformed Migraine to episodic:
    • Good compliance with preventive regimen
    • withdrawal from continuous use of analgesics for headache relief (medication overuse)
    • regular exercise

Study conclusion


Compliance factors are the most important factors that determine the reversion of transformed Migraine into episodic Migraine.

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