What are the recommended withdrawal strategies for patients with MOH, and how can I support them during this process?

Withdrawal of the overused medication is the treatment of choice in medication overuse headache ¹.

Advise patients to stop taking all overused acute headache medications for at least 1 month, preferably stopping drugs such as triptans, ergotamines, and simple analgesics abruptly ¹.

During withdrawal, inform patients that headache may initially worsen and that withdrawal symptoms such as nausea, vomiting, sleep disturbance, anxiety, and restlessness may occur ¹.

Support patients with close follow-up, including regular reviews to assess symptom response and provide ongoing reassurance and management ¹.

Use a headache diary to monitor headache frequency, duration, severity, and medication use during withdrawal ¹.

Plan withdrawal according to the patient's lifestyle and commitments, considering that initial worsening typically lasts 1–2 weeks, with headache improvement usually seen 1–2 weeks after withdrawal, but recovery may continue for 2–3 months ¹.

Review and reassess the underlying headache disorder 4–8 weeks after starting withdrawal, and manage accordingly ¹.

Consider prophylactic medication for the primary headache disorder during or after withdrawal if appropriate ¹.

Advise restricting future acute medication use to no more than 2 days per week to prevent relapse ¹.

Healthcare professionals can support patients by providing information, reassurance, and regular follow-up, and by considering referral to specialist if withdrawal is unsuccessful or complicated ¹.