Education is the most important measure. Short-acting drugs such as butalbital and most opioids are of higher risk for habituation than longer-acting drugs such as ibuprofen or naproxen. The first step is to stop the medication. Generally, this can be done abruptly. Pick a long weekend so withdrawal headache, which is common though temporary, is better tolerated. Start a preventative if the patient is not already on one. If the drug is butalbital or opioids, use a triptan during the withdrawal. There are several choices for rescue medications. I favor indomethacin in combination with metoclopramide and a steroid dose pack if that fails.
Treatment of Medication-Overuse Headaches
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