SynthesisThe journal of headache and pain2025
Network meta-analysis comparing efficacy of different strategies on medication-overuse headache.
Synthesis in The journal of headache and pain, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 10 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Peripheral nerve block in patients with medication-overuse headache: systematic review and meta-analysis.BMC neurology · 2026Pooled it
- Effect of Educational and Behavioral Interventions on Medication-Overuse Headache: A Systematic Review and Meta-Analysis.Pain research & management · 2026Pooled it
- Efficacy and safety of eptinezumab in adults with chronic migraine and medication-overuse headache who also received patient education: 24-week results of the randomized RESOLUTION trial.The journal of headache and pain · 2026Trial
- Eptinezumab With Patient Education for Chronic Migraine and Medication-Overuse Headache: The Randomized, Placebo-Controlled RESOLUTION Trial.Neurology · 2026Trial
- An exploration of possible future non-pharmacological multidisciplinary treatments to potentiate withdrawal strategy and recovery from medication overuse headache (MOH): a narrative review.Journal of oral & facial pain and headache · 2026Review
- CGRP and Migraine: Real-World Insights and Future Therapeutic Directions.Annual review of medicine · 2026Review
- Deprescribing and Anti-CGRP preventive therapy in medication-overuse headache associated with migraine: pathophysiological rationale and single-center real world evidence.Frontiers in drug safety and regulation · 2026Article
- Multisociety response to the proposed multi-jurisdictional local coverage determination on peripheral nerve blocks and procedures for chronic pain: A critical moment in Healthcare Policy for the United States.Interventional pain medicine · 2025Article
- Association Between Peripheral Inflammation Biomarkers and Clinical Phenotypes in Patients With Medication Overuse Headache: A Cross-sectional Study.Brain and behavior · 2025Article
- The potential application of electrophysiological indicators in TMS treatment for MOH.Frontiers in pain research (Lausanne, Switzerland) · 2025Review
Corrections and comments
- Erratum issued
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundMedication-overuse headache (MOH) is the most common secondary headache disorder, resulting from or leading to the frequent use of acute headache medications. Despite the availability of various treatment strategies, the optimal approach remains uncertain.
objectiveThis network meta-analysis (NMA) aimed to evaluate the comparative efficacy of different strategies for managing MOH, focusing on reducing monthly headache days.
methodsWe systematically reviewed randomized controlled trials (RCTs) comparing withdrawal strategies, including bridging therapies, the use of concurrent migraine prevention drugs, and additional education, in adult patients diagnosed with MOH. The primary outcome was the reduction in monthly headache days. Eligible studies were analyzed using a random-effects NMA model, integrating both direct and indirect evidence. Treatments were ranked using p-scores, and risk of bias was assessed using the Cochrane risk of bias tool 2.0.
resultsSixteen RCTs involving 3,000 participants were included. Compared to control, combination therapies, such as abrupt withdrawal with oral prevention and greater occipital nerve block and restriction of overused acute medication with oral prevention and Calcitonin gene-related peptide (CGRP) therapies, demonstrated the greatest efficacy, with reductions in monthly headache days of -10.6 (95% CI: [-15.03; -6.16]) and -8.47 (95% CI: [-12.78; -4.15]), respectively. Headache prevention strategies, including oral prevention (P), anti-calcitonin gene-related peptide (receptor) (CGRP(R)) therapies (A), and botulinum toxin (B) showed significant in reduction of monthly headache days, but no single initial prevention strategy demonstrates superior efficacy over the others. In contrast, abrupt withdrawal alone (W) showed no significant efficacy, with a mean difference of -2.77 (95% CI: [-5.74; 0.20]).
conclusionCombination therapies, including anti-CGRP(R) therapies and nerve blocks, appear to be the most effective strategies for MOH management, highlighting their potential as initial treatment options. While headache prevention strategies demonstrated similar efficacy, abrupt withdrawal alone was insufficient. The observed reduction in headache frequency after treatment suggests that strategies with greater efficacy may help lower the likelihood of MOH relapse.
trial registrationPROSPERO, CRD 42024620487.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.