1. COMOESTAS – Grant agreement no. 215366 Pre-Review meeting, Buenos Aires, November 27th, 2010 1 The principal results of the project WP5 A and WP5B Rigmor Jensen, Danish Headache Center (DHC), Glostrup Hospital, University of Copenhagen, Denmark

2. COMOESTAS – Grant agreement no. 215366 Pre-Review meeting, Buenos Aires, November 27th, 2010 Which drugs cause MOH?  Caffeine  Ergotamine  Dihydroergotamine  Triptans  Salicylates  Acetaminophen  Paracetamol  NSAIDs  Codein  Opiates  Tranquillisers  Barbiturates Combinations are frequent All pain killers can cause HEADACHE

3. COMOESTAS – Grant agreement no. 215366 Pre-Review meeting, Buenos Aires, November 27th, 2010 ICHD-II - “Medication-Overuse Headache” … a system whereby medication overuse headache became a default diagnosis in all patients with medication overuse would encourage doctors all over the world to do the right thing, namely, to take patients off medication overuse as the first step in a treatment plan. A.Headache present on ≥15 days/month B.Regular overuse for >3 months of one or more acute/symptomatic treatment drugs as defined under sub form 8.2 1. Ergotamine, triptans, opioids or combination analgesic medications on ≥10 days/month on a regular basis for >3 months 2. Simple analgesics or any combination of ergotamine, triptans, analgesics, opioids on ≥15 days/ month on a regular basis for > 3 months without overuse of any single class alone C. Headache has developed or markedly worsened during medication overuse II revision, 2006

4. COMOESTAS – Grant agreement no. 215366 Pre-Review meeting, Buenos Aires, November 27th, 2010 Objectives  Primary  Number of relapses in the two follow-up periods in the two arms  Secondary  Disease-related  Number of days with headache before and after detoxification in the two arms  Number of days with migraine before and after detoxification in the two arms  Number of days with tension-type headache before and after detoxification in the two arms  Number of days with other types of headache before and after detoxification in the two arms 4

5. COMOESTAS – Grant agreement no. 215366 Pre-Review meeting, Buenos Aires, November 27th, 2010 Overused drug at inclusion mean (SD) 5 Classical (N=402)IEPR (N=306) Ergotamine11382 Triptans8372 Analgesics184141 Opioids37 Combinations10882 Intakes days/mth23.3(9.9)21.6(6.1)*

6. COMOESTAS – Grant agreement no. 215366 Pre-Review meeting, Buenos Aires, November 27th, 2010 Headache Frequency(days/mth ) 6 Classical IEPR

7. COMOESTAS – Grant agreement no. 215366 Pre-Review meeting, Buenos Aires, November 27th, 2010

9. Major Results 9 ClassicalIEPR MIDAS visit 156.669.7*** MIDAS visit 328.7***18.2 *** HAEDS visit 16.96.2 HAEDS visit 34.43.4*** VHQoL visit 125.126.1 VHQoL visit 330.2***30.4***

10. COMOESTAS – Grant agreement no. 215366 Pre-Review meeting, Buenos Aires, November 27th, 2010 Critical issues with impact on the overall project results  IEPR not completed  Only preliminary results are presented  High number of patients screened, especially in IEPR  Selection of younger and IT-experienced patients in IEPR  More patients with chronic migraine in IEPR 10

11. COMOESTAS – Grant agreement no. 215366 Pre-Review meeting, Buenos Aires, November 27th, 2010 Preliminary conclusions  It is possible to conduct a multicenter EU-LA study in headache  Detoxification is very successfull and the headache frequency is significantly reduced  So far the relapse rate is relatively low  The burden and costs of MOH are significant  The overall impact on daily life, psychiatric comorbidity and QoL is improved after detoxification 11