Intervention: TaU condition
headaches, pain
DRUGS WITHDRAWAL, REBOUND HEADACHE
TaU consisted of three main elements: overused drugs withdrawal; education on proper medication use, and prescription of tailored prophylaxis.Withdrawal was carried out in a hospital setting, either in day-hospital or ward, and lasted 5–8 days. It consisted of: abrupt withdrawal of overused symptomatic medications; intravenous hydration for the whole period; intravenous steroids and ademetionine for 5 days followed by oral prescription of steroids for other 3–5 days; oral benzodiazepines; intravenous methoclopramide or indomethacin if needed for intense rebound headache.Patients’ education was focused on both proper medication use and lifestyle issues. Patients were encouraged to use acute medications only for headaches that were very disabling and painful, operationally defined as 8 or more on a 0–10 pain scale (no pain at all – pain as bad as it can be). As the first-line treatment, Eletriptan (40 mg) and/or Almotriptan (12.5 mg) were recommended, and Indomethacin (50 mg) as the second line; other NSAIDs should be taken if they had already proven to be effective. Finally, in any case, they were strongly advised to avoid opioids. With reference to lifestyle issues, patients were encouraged to engage in a moderate level of aerobic physical activity for approximately 45 min twice per week, to maintain a suitable level of hydration, to consume 3 meals each day on a regular basis (emphasizing breakfast) and, finally, to care for sleep hygiene, i.e. sleeping around 7–8 h per night and trying to be consistent with timetables for sleep time.By the end of withdrawal treatment, patients were prescribed tailored prophylaxis based on their clinical characteristics and previous experiences with single compounds. The study used marketed pharmacological compounds that are commonly prescribed in our center on a daily basis (e.g. antiepileptic, antidepressant or anti-hypertensive drugs, OnabotulinumtoxinA, and Calcitonin gene-related peptide monoclonal antibodies – see Burch 2021 for a review [