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This Article Figures Only Full Text Full Text (PDF) CME: Take the course for this article: Volume 69, Number 01, July 03, 2007 Italian Translation All Versions of this Article: 01.wnl.0000263652.46222.e8v1 69/1/26    most recent Correspondence: Submit a response Correspondence: View responses Alert me when this article is cited Alert me when Correspondence are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bøe, M. G. Articles by Salvesen, R. Search for Related Content PubMed PubMed Citation Articles by Bøe, M. G. Articles by Salvesen, R. Related Collections All Headache Migraine Tension headache Clinical trials Randomized controlled (CONSORT agreement)

Prednisolone does not reduce withdrawal headache

A randomized, double-blind study

From the Department of Neurology, Sørlandet Hospital, Kristiansand, Norway (M.G.B., Å.M.); Hospital of Rehabilitation, Rikshospitalet University Hospital, Kristiansand, Norway (Å.M.); Institute of Clinical Medicine, University of Bergen, Bergen, Norway (Å.M.); Department of Neurology, Nordland Hospital, Bodø, Norway (R.S.); and Department of Neurology, University of Tromsø, Tromsø, Norway (R.S.).

Address correspondence and reprint requests to Dr. Magne G. Bøe, Sorlandet Hospital, Neurological Department, Kristiansand, Norway 4604; magne.geir.boe{at}sshf.no

Introduction: Medication overuse headache is a condition where abrupt drug withdrawal is considered the treatment of choice.

Objective: To study whether prednisolone given orally the first 6 days after medication withdrawal reduces headache intensity during the same period.

Methods: From August 2003 through November 2005, we included patients aged 18 to 70 years with probable medication overuse headache. The study was randomized, double-blind, and placebo controlled. The patients were hospitalized for 3 days to start medication withdrawal. They were randomly assigned to receive prednisolone 60 mg on days 1 and 2, 40 mg on days 3 and 4, and 20 mg on days 5 and 6 (Group A) or placebo tablets for 6 days (Group B). Headache intensity was recorded in a diary for a month before withdrawal (baseline) and throughout the study period of 28 days. The primary endpoint was a calculated mean headache (MH), based on number of days with headache and mean intensity the first 6 days after withdrawal.

Results: We included 26 men and 74 women. Sixty-five had migraine, 13 had tension-type headache, and 22 had both migraine and tension-type headache. Baseline headache days were 25.4 (CI 24.3 to 26.4). Baseline MH was 1.6 (CI 1.41 to 1.69). Fifty-one received Regimen A, and 49 received Regimen B. Baseline features were similar. During the first 6 days after withdrawal, headache was similar in Groups A and B (MH 1.48 [CI 1.28 to 1.68] vs 1.61 [CI 1.41 to 1.82], p = 0.34).

Conclusion: Prednisolone has no effect on withdrawal headache in unselected patients with chronic daily headache and medication overuse.

Editorial, see page 14

This article was previously published in electronic format as an Expedited E-Pub on May 2, 2007, at www.neurology.org.

Disclosure: The authors report no conflicts of interest.

Received December 15, 2006. Accepted in final form March 5, 2007.

This article has been cited by other articles:

				L. J.M.M. Mulder, E. L.H. Spierings, M. G. Boe, A. Mygland, and R. Salvesen PREDNISOLONE DOES NOT REDUCE WITHDRAWAL HEADACHE: A RANDOMIZED, DOUBLE-BLIND STUDY Neurology, February 5, 2008; 70(6): 491 - 491. [Full Text] [PDF]

				Prednisolone for Medication Withdrawal Headache? Journal Watch Neurology, September 25, 2007; 2007(925): 3 - 3. [Full Text]

				Steroids Ineffective in Patients with Medication-Overuse Headache Journal Watch (General), July 12, 2007; 2007(712): 5 - 5. [Full Text]

				H.-C. Diener How to treat medication overuse headache: Prednisolone or no prednisolone? Neurology, July 3, 2007; 69(1): 14 - 15. [Full Text] [PDF]

Correspondence: