Stephen Silberstein, MD: Treating Medication Overuse Headache


The director of the Jefferson Headache Center at Jefferson University Hospital discussed the need for physicians to revisit how they treat patients with chronic migraine who have developed medication overuse headache.

“We need to change our way of thinking. People used to say detox first, prevent later. I think that’s wrong.”

Medication overuse headache has been estimated to impact up to 2% of the worldwide population disorders.1 For quite some time, it has been believed that in order for these patients to be treated with a preventative therapy, they must first be detoxed. Some literature has begun to dispute this.

One such paper was presented at the 2019 American Academy of Neurology (AAN) Annual Meeting, Stephen Silberstein, MD, director, Jefferson Headache Center, Jefferson University Hospital, presented a study of fremenezumab, a recently approved calcitonin gene-related peptide inhibitor marketed by Teva Pharmaceutical as Ajovy, in this patient group. Ultimately, it showed that among those with medication overuse at baseline who received either a quarterly (n = 201) or monthly (n = 198) dose, or placebo (n = 188), more patients treated with fremanezumab reported no medication overuse during the treatment period (quarterly: 55%; P = .0389; monthly: 61%; P = .0024) than those who received placebo (46%).2

To discuss what this means for the clinical approach to managing patients who have developed medication overuse headache, NeurologyLive® spoke with Silberstein about the effect of fremanezumab versus placebo on medication overuse and acute headache medication use in patients with chronic migraine.

For more coverage of AAN 2019, click here.


1. Kristoffersen ES, Lundqvist C. Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Drug Saf. 2014;5(2):87-99. doi: 10.1177/2042098614522683.

2. Silberstein S, Ashina S, Katarava Z, et al. The Impact of Fremanezumab on Medication Overuse in Patients With Chronic Migraine. Presented at: 2019 American Academy of Neurology Annual Meeting. May 4-10, 2019; Philadelphia, PA. Poster 026.

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