Withdrawal of the overused medication is the treatment of choice in medication overuse headache NICE CKS.
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 NICE CKS.
During withdrawal, inform patients that headache may initially worsen and that withdrawal symptoms such as nausea, vomiting, sleep disturbance, anxiety, and restlessness may occur NICE CKS.
Support patients with close follow-up, including regular reviews to assess symptom response and provide ongoing reassurance and management NICE CKS.
Use a headache diary to monitor headache frequency, duration, severity, and medication use during withdrawal NICE CKS.
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 NICE CKS.
Review and reassess the underlying headache disorder 4–8 weeks after starting withdrawal, and manage accordingly NICE CKS.
Consider prophylactic medication for the primary headache disorder during or after withdrawal if appropriate NICE CKS.
Advise restricting future acute medication use to no more than 2 days per week to prevent relapse NICE CKS.
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 NICE CKS.