Stop the Medications Causing MOH
The first few days will be difficult, but over-the-counter medications can often be stopped “cold turkey.” Medications containing caffeine will produce caffeine withdrawal in addition to the effect of stopping the analgesic.
Bridge therapy, such as a short course of corticosteroids, a long-acting triptan, or DHE, may be used on an outpatient basis. With severe overuse, hospitalization or outpatient infusion treatment may be needed.
Discontinuing daily narcotics, opioids, and barbiturates may cause physical withdrawal so these drugs should not be stopped abruptly. Inpatient treatment to withdraw medications, break the headache cycle, and adjust preventive medications may be needed.
Begin Preventive Therapy
Stopping the offending agent may be enough to control the headaches, or at least restore their baseline frequency. Starting a preventive medication while eliminating the overused medications often leads to more rapid control of headaches overall. Having the extra protection of taking a preventive medication also eliminates some of the anxiety associated with the possibility of the headaches returning.
Address the Emotional and Behavioral Components
“Reaching for the pill bottle” on a frequent basis is a counterproductive solution to managing headaches. Cognitive-behavioral therapy, stress-reduction techniques, lifestyle modifications, and addressing underlying anxiety and depression are often needed in combination with the other treatment strategies mentioned.