A study comparing three treatment strategies for medication overuse headache shows that all are effective, but one — preventive therapy plus withdrawal of the overused drug — has the edge.

Danish researchers randomly allocated 102 people with medication overuse headache to one of three strategies: use of a preventive plus complete withdrawal of the over-used medication for two months with limited use allowed thereafter; a preventive medication alone; or withdrawal for two months (with limited use thereafter).

Participants were attendees at the Danish Headache Centre, Glostrup. Their mean age was 44 years, 79% were female and they had headaches a mean of 27 days per month, with 52% diagnosed as having chronic migraine, 16% with tension-type headache and 33% with episodic migraine with tension-type headache.

They had been overusing short-term medications for relief for two years on average, with 33% taking combination analgesics, 28% taking simple analgesics, 18% using triptans and 21% using a mix of treatments, according to the report in JAMA Neurology.