Treatment of medication‐overuse headache in children and adolescents: A systematic review

• Published in: Headache Vol. 65; no. 7; pp. 1148 - 1159
• Main Authors: VanderPluym, Juliana H., Cheng, Nan, Zhu, Ye, Wang, Zhen, Morris, Cynthia, Jones, Andrew, Gelfand, Amy A., Gautreaux, Jesssica
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2025
• Subjects: Adolescent; Adolescents; analgesic headache; Child; Children; Children & youth; Clinical trials; Criteria; Drugs; Headache; Headache Disorders, Secondary - therapy; Heterogeneity; Humans; medication‐overuse headache; Observational studies; Patients; pediatric; Pediatrics; Randomized Controlled Trials as Topic; rebound headache; Systematic review; Teenagers; Withdrawal; rebound headache; adolescent; medication‐overuse headache; analgesic headache; child; pediatric
• ISSN: 0017-8748; 1526-4610; 1526-4610
• DOI: 10.1111/head.14973

Objective To examine the effectiveness of treatment strategies for medication‐overuse headache (MOH) in children and adolescents. Background There are no guidelines for the treatment of adult or pediatric patients with MOH. However, research pertaining to MOH in adults is far outpacing research in children and adolescents. Methods A systematic review of evidence on treatment for MOH in children and adolescents was performed via PubMed, Embase, Web of Science, PsycINFO, and Cochrane from database inception to October 2024 for articles with the subject headings and keywords for MOH and pediatric, children, and/or adolescent. Inclusion criteria were: (i) randomized controlled trials and retrospective and prospective observational studies, (ii) children and adolescents aged <18 years with chronic headaches and with medication overuse (MO) or MOH, and (iii) interventions addressing MO or MOH, including pharmacologic and behavioral interventions. At least two independent reviewers screened citations and full‐text articles independently. Results A total of 16 studies (one randomized control trial, six prospective observational studies and nine retrospective observational studies) were identified as meeting final inclusion criteria, resulting in 7978 total participants with a subset of those having MO, MOH or probable MOH. Participants ranged in mean age from 10 to 14.7 years, with 7.1%–46.2% male participants. All the studies recruited patients from an outpatient setting. Interventions used in the studies included withdrawal of the overused acute medication, initiation of preventive medication, patient education, physiotherapy and psychological treatment, and motivational interviewing. Multimodal therapy was studied more than single therapeutic intervention. There was vast heterogeneity across the studies, including study design, diagnostic criteria, intervention type, and outcomes. Conclusion From the data available, there does not seem to be a singular superior treatment approach. Accordingly, the most appropriate treatment modality will need to be tailored to the patient and their caregivers. Further research is required regarding management of MOH in children and adolescents. Plain Language Summary There is little information about how to treat headaches in children and adolescents caused by using acute medications too frequently (i.e., medication overuse headache or MOH). In this study, we reviewed data from sixteen studies about this topic, and we found that there are many different medication and non‐medication strategies that may provide some benefit. However, we found that the data did not appear to support that one treatment method is better than any other, suggesting that more research on treatments for MOH is needed.