ArticleThe journal of headache and pain2025
Ergotamine and triptans induced medication-overuse headache: a real-world population-based comparative study from the Northern Thai headache registry.
Article 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. Not yet cited in PubMed.
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Abstract
backgroundMedication-overuse headache (MOH) remains a leading cause of chronic daily headache globally. Although triptans are the predominant implicated in high-income countries, ergotamine continues to be widely used in many low- and middle-income settings. Comparative data on ergotamine- versus triptan-induced MOH remain limited.
methodsWe analyzed prospective data from the Northern Thai Headache Registry, enrolling patients with ergotamine-MOH, triptan-MOH, or dual-MOH. Demographic and clinical characteristics, treatment outcomes, recurrence rates, and withdrawal symptoms were evaluated over 12 months. Outcomes included changes in Headache Impact Test (HIT-6) scores, recurrence-free survival, and adverse events during withdrawal.
resultsA total of 117 MOH patients were included: 61 (52.1%) with ergotamine-MOH, 44 (37.6%) with triptan-MOH, and 12 (10.3%) with dual-MOH. Patients with ergotamine-MOH experienced significantly more withdrawal symptoms compared to those with triptan-MOH (P < 0.01). In contrast, recurrence rates were highest among dual-MOH patients (P < 0.01). Improvement in HIT-6 scores was observed across all groups, though ergotamine-MOH patients showed slower recovery trajectories. Kaplan-Meier analysis demonstrated a higher risk of recurrence in dual-MOH compared to single-agent MOH.
conclusionsErgotamine-induced MOH is linked to more severe withdrawal symptoms, whereas dual-MOH carries the greatest risk of recurrence. These findings highlight the importance of tailored withdrawal strategies and close monitoring, particularly in resource-limited settings where ergotamine remains widely available. They also support policy initiatives aimed at restricting over-the-counter ergotamine and expanding access to safer acute treatment options.
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