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Open Access 01-03-2021 | Migraine | Original Article

Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study

Authors: Silvia Benemei, Chiara Lupi, Francesco De Cesaris, Niccolò Lombardi, Alessandra Bettiol, Alberto Chiarugi, Pierangelo Geppetti, Valentina Galli, Chiara Pracucci, Brunella Occupati, Guido Mannaioni

Published in: Neurological Sciences | Issue 3/2021

Abstract

Objectives

A refractory chronic migraine (RCM) accompanied by medication-overuse headache (MOH) is an extremely disabling disease. Evidence suggests that in selected patients, chronic opioids may be a valuable therapeutic option for RCM. The aim of the present study was to evaluate the effectiveness and safety of prophylaxis with low-dose methadone (LDM) in patients affected by RCM with continuous headache and MOH.

Methods

A prospective cohort study was performed between May 2012 and November 2015 at the Headache Center and Toxicology Unit of the Careggi University Hospital. Eligible patients were treated with prophylactic LDM and followed up for 12 months. Headache exacerbations, pain intensity, use of rescue medications, and occurrence of adverse drug reactions (ADRs) were recorded.

Results

Thirty patients (24 females, median age 48 years) were enrolled. Nineteen (63%) patients dropped out, mainly because of early ADRs (n = 10), including nausea, vomiting, and constipation. At last available follow-up, LDM was associated with a significant decrease in the number of headache attacks/month (from a median of 45 (interquartile range 30–150) to 16 (5–30), p < 0.001), in pain intensity (from 8.5 (8–9) to 5 (3–6), p < 0.001), and in the number of rescue medications consumed per month (from 95 (34–240) to 15 (3–28), p < 0.001). No misuse or diversion cases were observed.

Conclusion

LDM could represent a valuable and effective option in selected patients affected by RCM with continuous headache and MOH, although the frequency of early ADRs poses major safety concerns. Randomized controlled trials are needed to confirm the efficacy and safety of LDM prophylaxis.

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Title: Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study
Authors: Silvia Benemei
Chiara Lupi
Francesco De Cesaris
Niccolò Lombardi
Alessandra Bettiol
Alberto Chiarugi
Pierangelo Geppetti
Valentina Galli
Chiara Pracucci
Brunella Occupati
Guido Mannaioni
Publication date: 01-03-2021
Publisher: Springer International Publishing
Keywords: Migraine
Opioids
Opioids
Methadone
Medication Overuse Headache
Headache
Published in: Neurological Sciences / Issue 3/2021
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04602-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Low-dose methadone for refractory chronic migraine accompanied by medication-overuse headache: a prospective cohort study

Abstract

Objectives

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

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