Over five years, 70.4% of chronic migraine patients with medication overuse headache achieved at least a 75% reduction in headache days using withdrawal therapy, preventive medications, and optional anti-CGRP monoclonal antibodies.
70.4% achieved ≥75% reduction at 5 yearsPatients started with an average of 25.2 headache days per month — most of the month
What the researchers found
Among 142 patients with chronic migraine and medication overuse headache (MOH), treatment with abrupt medication withdrawal, conventional preventive therapy, and optional anti-CGRP monoclonal antibodies produced significant long-term improvements. Patients started with an average of 25.2 headache days per month.
At one-year follow-up, 51.4% of patients achieved a ≥75% reduction in headache days per month (HDM). By the five-year follow-up, this improved to 70.4% achieving ≥75% reduction in HDM, demonstrating that outcomes continued to improve over time with sustained treatment.
Why it matters
Medication overuse headache affects millions worldwide and creates a vicious cycle where the very medications used to treat headaches end up making them worse. This study provides rare long-term real-world data showing that a structured approach — stopping overused medications and adding modern preventive treatments like anti-CGRP antibodies — can produce sustained improvements over five years, with outcomes actually improving over time rather than plateauing.
How the study worked
This was a single-center, prospective, descriptive study at a tertiary headache center in Brazil. Researchers enrolled 142 consecutive patients diagnosed with chronic migraine and medication overuse headache through convenience sampling. All patients underwent abrupt withdrawal of overused medications, received transition therapy, and were started on preventive treatments with optional anti-CGRP monoclonal antibodies. Clinical data including headache days per month were collected at baseline, one year, and five years.
What this study cannot tell us
This was a single-center study in Brazil using convenience sampling, limiting generalizability. There was no control group or randomization, so improvements cannot be attributed specifically to anti-CGRP antibodies versus other components of the treatment protocol. The study did not report what proportion of patients received anti-CGRP antibodies versus conventional preventives only. Dropout rates over five years were not detailed in the abstract.
How to read the evidence
This is a prospective observational study without randomization or a control group. While it provides valuable real-world long-term data, the lack of blinding and controls means the specific contribution of anti-CGRP antibodies cannot be isolated from other treatment components.
When this study was published
Published in 2024, this is a recent study reflecting current clinical practice with anti-CGRP monoclonal antibodies, which have been available since 2018.
The bigger picture
Anti-CGRP monoclonal antibodies (like erenumab, fremanezumab, and galcanezumab) represent one of the most significant advances in migraine treatment in decades. This study adds real-world, long-term evidence supporting their use in one of the most challenging migraine populations — those with medication overuse. The improving outcomes over five years suggest that anti-CGRP therapies may help break the cycle of medication overuse more effectively than older preventive approaches alone.
Questions still open
- How much of the improvement was specifically due to anti-CGRP antibodies versus the medication withdrawal and conventional preventives?
- What were the relapse rates among patients who discontinued anti-CGRP therapy during the five-year period?
- Would earlier introduction of anti-CGRP antibodies produce even better one-year outcomes?
Common questions
What is medication overuse headache and how does it develop?
What are anti-CGRP monoclonal antibodies and how do they help with headaches?
Read the original research
One-Year and Five-Year Outcomes in Medication Overuse Headache: A Real-World Study.
Cureus, 16(10), e72347
Citation
Krymchantowski, Abouch; Jevoux, Carla; Krymchantowski, Ana Gabriela; Dominguez-Moreno, Rogelio; Pereira Silva-Néto, Raimundo. (2024). One-Year and Five-Year Outcomes in Medication Overuse Headache: A Real-World Study.. Cureus, 16(10), e72347. https://doi.org/10.7759/cureus.72347