Abstract
Objectives : Medication-overuse headache (MOH) is caused by daily use of analgesics due to severe headache such as migraine. Withdrawal therapy is the only treatment of choice for this condition. In recent study, relapse rate after successful withdrawal therapy were 38% in the first year and around 42% after 4 years, therefore the prevention of relapse is the important issue. We will report experience of treatment for 10 cases of MOH and give consideration to availability of psychosomatic approach and treatment strategy. Subjects and method : We treated 10 MOH patients not only with medication but also with lifestyle guidance, headache-education and psychosomatic approaches including accepting, supporting, reassuring, self monitoring and clarifying the outcome. Result : Eight patients were introduced into withdrawal therapy and 5 patients have been discontinuing for over one year. Another patient was able to replace ergotamine with less detrimental drugs as the second best. One case had relapsed and three patients could not be followed up because of dropout and move. Common denominators of the patient who succeeded in discontinuing drugs suggest that they understood MOH mechanisms well enough and had a spontaneous will to stop drugs. The treatment of MOH requires the following four strategic stages : Awareness-Understanding-Decision-Action. Understanding will not be insured without awareness, so it is no use making a decision without understanding. Furthermore, patient will move into action and continue it consistently when they decided of their own will, and not by doctor's direction or enforcement. The framework of this approach is based on "the discount matrix" model of transactional analysis. Conclusion : In the treatment of MOH, it is necessary to treat patients not only with medical approach but also with psychosomatic approach which can bring their spontaneity step by step without discounting important information of reality.
