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ARTICLES: Magne G. Bøe, Åse Mygland, and Rolf Salvesen Prednisolone does not reduce withdrawal headache: A randomized, double-blind study Neurology 2007; 69: 26-31 [Abstract] [Full text] [PDF]

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Prednisolone does not reduce withdrawal headache: A randomized, double-blind study

Laurence J.M.M. Mulder, Egilius L.H. Spierings   (21 September 2007)

Reply from the authors

Magne G. Bøe, Åse Mygland, Rolf Salvesen   (21 September 2007)

Prednisolone does not reduce withdrawal headache: A randomized, double-blind study 21 September 2007
Laurence J.M.M. Mulder, Ikazia Ziekenhuis Montessoriweg 1, 3083 AN Rotterdam, the Netherlands, Egilius L.H. Spierings Send Correspondence to journal: Re: Prednisolone does not reduce withdrawal headache: A randomized, double-blind study ljmm.mulder{at}ikazia.nl Laurence J.M.M. Mulder, et al.	We read the article by Bøe et al with interest. [1] The purpose of diagnosing medication overuse headache (MOH) is to treat with medication withdrawal and improve headaches. Despite the IHS diagnostic criteria, MOH can only be diagnosed retrospectively based on headache improvement after medication withdrawal. As a group, the subjects studied experienced only minimal headache improvement after medication withdrawal. Therefore, as a group, they did not suffer from MOH. There is no purpose in withdrawing them from medication and/or prescribing them prednisolone. Reference: 1. Bøe MG, Mygland Å, Salvesen R. Prednisolone does not reduce withdrawal headache: A randomized, double-blind study. Neurology 2007; 69: 26-31. Disclosure: The authors report no conflicts of interest.
Reply from the authors 21 September 2007
Magne G. Bøe, Neurology Department, Sorlandet Hospital Kristiansand, Norway 4604, Åse Mygland, Rolf Salvesen Send Correspondence to journal: Re: Reply from the authors magne.geir.boe{at}sshf.no Magne G. Bøe, et al.	We thank Dr. Mulder for commenting on our study of treatment with steroids during withdrawal from probable medication overuse headache (MOH). [1] Dr Mulder suggests that the patients in our study did not suffer from MOH. Our study design did not permit us to confirm or reject this claim since we only followed the patients for 28 days after medication withdrawal. The IHS classification demands that patients are followed for two months in order to determine whether the condition was a genuine MOH. [2] However, we state in the Abstract and Methods that we included patients with probable medication overuse headache (8.2.7 in the IHS classification). [2] All the patients in our study fulfilled the criteria for this condition. We do not know whether they undeniably fulfill the criteria for genuine MOH. It is likely that some of them do and we are investigating this possibility. In clinical practice, it is only possible to distinguish between these disorders in retrospect, making our findings very useful in everyday clinical headache practice as retrospective data are not available in this situation. References 2. The International Classification of Headache Disorders. Cephalalgia 2004; 24 (Suppl 1): 94-95. Disclosures: The authors report no conflicts of interest. Disclosure: The authors report no conflicts of interest.