Affordable Access

deepdyve-link
Publisher Website

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

Authors
  • Benemei, Silvia1
  • Lupi, Chiara2
  • De Cesaris, Francesco2
  • Lombardi, Niccolò3
  • Bettiol, Alessandra3
  • Chiarugi, Alberto4
  • Geppetti, Pierangelo4
  • Galli, Valentina5
  • Pracucci, Chiara5
  • Occupati, Brunella5
  • Mannaioni, Guido3
  • 1 Headache Center, Careggi University Hospital, Florence, Italy. [email protected] , (Italy)
  • 2 Headache Center, Careggi University Hospital, Florence, Italy. , (Italy)
  • 3 NEUROFARBA Department, Toxicology Unit, Careggi University Hospital, University of Florence, Florence, Italy. , (Italy)
  • 4 Department of Health Sciences, Headache Center, Careggi University Hospital, University of Florence, Florence, Italy. , (Italy)
  • 5 Toxicology Unit, Careggi University Hospital, Florence, Italy. , (Italy)
Type
Published Article
Journal
Neurological Sciences
Publisher
Springer-Verlag
Publication Date
Mar 01, 2021
Volume
42
Issue
3
Pages
987–994
Identifiers
DOI: 10.1007/s10072-020-04602-3
PMID: 32691178
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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. 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.

Report this publication

Statistics

Seen <100 times