Skip to main content

Advertisement

SpringerLink
Log in

A Critical Evaluation on MOH Current Treatments

  • Headache (JR Couch, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Opinion statement

Migraine is the most frequent neurological disorder observed in clinical practice characterized by moderate to severe pain attacks associated with neurological, gastrointestinal, and dysautonomic symptoms. Each year, 2.5% of patients with episodic migraine develop chronic migraine (CM). CM is characterized by high frequency of the attacks that may result into chronic intake of abortive medications. Nearly, the 70% of CM patients referring to tertiary head centers show acute pain medications overuse that may lead to the development of medication overuse headache (MOH). The management of MOH requires three steps: (1) education, (2) withdrawal of the overuse drug and detoxification, and (3) re-prophylaxis. In the last years, several real-life prospective studies provided further evidence in clinical setting of the onabotulinumtoxinA 155–195 U efficacy for the headache prophylaxis in CM with MOH patients. There is a general agreement on two factors: (1) withdrawal of the overuse drug is condicio sine qua non to reverse the pattern to medium–low-frequency migraine, and (2) the focus of management needs to shift from acute treatment of pain to prevention of headache. CM patients close to developing MOH, patients with high-frequency episodic migraine, and those already abusing of drugs require special attention and should refer to tertiary headache centers. For all of them, a solution could be an “early treatment.” Early should be their referral to a tertiary headache center, early should be the withdrawal of the overuse drug and a proper detoxification, and perhaps early should be the start of a preventative therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629–808.

    Article  Google Scholar 

  2. Steiner TJ, Birbeck GL, Jensen R, Katsarava Z, Martelletti P, Stovner LJ. The Global Campaign, World Health Organization and Lifting The Burden: collaboration in action. J Headache Pain. 2011;12:273–4.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bloudek LM, Stokes M, Buse DC, Wilcox TK, Lipton RB, Goadsby PJ, et al. Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS). J Headache Pain. 2012;13:361–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743–800.

    Article  PubMed Central  Google Scholar 

  5. Steiner TJ, Birbeck GL, Jensen RH, Katsarava Z, Stovner LJ, Martelletti P. Headache disorders are third cause of disability worldwide. J Headache Pain. 2015;16:58.

    Article  PubMed  PubMed Central  Google Scholar 

  6. • Steiner TJ, Stovner LJ, Vos T. GBD 2015: migraine is the third cause of disability in under 50s. J Headache Pain. 2016;17:104. This article reports how migraine is ranked by WHO as the third of disability in under 50s.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lipton RB. Tracing transformation: chronic migraine classification, progression, and epidemiology. Neurology. 2009;72:S3–7.

    Article  PubMed  Google Scholar 

  8. Buse DC, Manack A, Serrano D, Turkel C, Lipton RB. Sociodemographic and comorbidity profiles of chronic migraine and episodic migraine sufferers. J Neurol Neurosurg Psychiatry. 2010;81:428–32.

    Article  CAS  PubMed  Google Scholar 

  9. Blumenfeld AM, Varon SF, Wilcox TK, Buse DC, Kawata AK, Manack A, et al. Disability, HRQoL and resource use among chronic and episodic migraineurs: results from the International Burden of Migraine Study (IBMS). Cephalalgia. 2011;31:301–15.

    Article  CAS  PubMed  Google Scholar 

  10. Stewart WF, Wood GC, Manack A, Varon SF, Buse DC, Lipton RB. Employment and work impact of chronic migraine and episodic migraine. J Occup Environ Med. 2010;52:8–14.

    Article  PubMed  Google Scholar 

  11. Negro A, D’Alonzo L, Martelletti P. Chronic migraine: comorbidities, risk factors, and rehabilitation. Intern Emerg Med. 2010;(Suppl 1):S13–9.

  12. Lampl C, Thomas H, Tassorelli C, Katsarava Z, Laínez JM, Lantéri-Minet M, et al. Headache, depression and anxiety: associations in the Eurolight project. J Headache Pain. 2016;17:59.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Loder E. Triptan therapy in migraine. N Engl J Med. 2010;363:63–70.

    Article  CAS  PubMed  Google Scholar 

  14. Dodick DW, Martin VT, Smith T, Silberstein S. Cardiovascular tolerability and safety of triptans: a review of clinical data. Headache. 2004;44:S20–30.

    Article  PubMed  Google Scholar 

  15. Bigal ME, Serrano D, Reed M, Lipton RB. Chronic migraine in the population: burden, diagnosis, and satisfaction with treatment. Neurology. 2008;71:559–66.

    Article  PubMed  Google Scholar 

  16. Negro A, Rocchietti-March M, Fiorillo M, Martelletti P. Chronic migraine: current concepts and ongoing treatments. Eur Rev Med Pharmacol Sci. 2011;15:1401–20.

    CAS  PubMed  Google Scholar 

  17. Lionetto L, Borro M, Curto M, Capi M, Negro A, Cipolla F, et al. Choosing the safest acute therapy during chronic migraine prophylactic treatment: pharmacokinetic and pharmacodynamic considerations. Expert Opin Drug Metab Toxicol. 2016;12:399–406.

    Article  CAS  PubMed  Google Scholar 

  18. Aurora SK, Dodick DW, Turkel CC, DeGryse RE, Silberstein SD, PREEMPT 1 Chronic Migraine Study Group, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia. 2010;30:793–803.

    Article  CAS  PubMed  Google Scholar 

  19. Diener HC, Dodick DW, Aurora SK, Turkel CC, DeGryse RE, PREEMPT 2 Chronic Migraine Study Group, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia. 2010;30:804–14.

    Article  CAS  PubMed  Google Scholar 

  20. Dodick DW, Turkel CC, DeGryse RE, Aurora SK, Silberstein SD, PREEMPT Chronic Migraine Study Group, et al. OnabotulinumtoxinA for treatment of chronic migraine: pooled results from the double-blind, randomized, placebo-controlled phases of the PREEMPT clinical program. Headache. 2010;50:921–36.

    Article  PubMed  Google Scholar 

  21. • Martelletti P, Katsarava Z, Lampl C, Magis D, Bendtsen L, Negro A, et al. Refractory chronic migraine: a consensus statement on clinical definition from the European headache federation. J Headache Pain. 2014;28(15):47. An important attempt to clinically define refractory chronic migraine.

    Article  Google Scholar 

  22. Diener HC, Limmroth V. Medication overuse headache: a worldwide problem. Lancet Neurol. 2004;3:475–83.

    Article  PubMed  Google Scholar 

  23. Natoli JL, Manack A, Dean B, Butler Q, Turkel CC, Stovner L, et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010;30:599–609.

    Article  CAS  PubMed  Google Scholar 

  24. •• Thorlund K, Sun-Edelstein C, Druyts E, Kanters S, Ebrahim S, Bhambri R, et al. Risk of medication overuse headache across classes of treatments for acute migraine. J Headache Pain. 2016;17:107. This study evaluated whether certain classes of acute migraine drugs are more likely to elicit MOH than others.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Meskunas CA, Tepper SJ, Rapoport AM, Sheftell FD, Bigal ME. Medications associated with probable medication overuse headache reported in a tertiary care headache center over a 15-year period. Headache. 2006;46:766–72.

    Article  PubMed  Google Scholar 

  26. Negro A, Martelletti P. Chronic migraine plus medication overuse headache: two entities or not? J Headache Pain. 2011;12:593–601.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Jonsson P, Jakobsson A, Hensing G, Linde M, Moore C, Hedenrud T. Holding on to the indispensable medication—a grounded theory on medication use from the perspective of persons with medication overuse headache. J Headache Pain. 2013;14:43.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wiendels NJ, Knuistingh Neven A, Rosendaal FR, Spinhoven P, Zitman FG, Assendelft WJ, et al. Chronic frequent headache in the general population: prevalence and associated factors. Cephalalgia. 2006;26:1434–42.

    Article  CAS  PubMed  Google Scholar 

  29. Robberstad L, Dyb G, Hagen K, Stovner LJ, Holmen TL, Zwart JA. An unfavourable lifestyle and recurrent headaches among adolescents: the HUNT study. Neurology. 2010;75:712–7.

    Article  CAS  PubMed  Google Scholar 

  30. Hagen K, Linde M, Steiner TJ, Stovner LJ, Zwart JA. Risk factors for medication overuse headache: an 11-year follow-up study. The Nord-Trøndelag Health Studies. Pain. 2012;153:56–61.

    Article  PubMed  Google Scholar 

  31. Schramm SH, Moebus S, Lehmann N, Galli U, Obermann M, Bock E, et al. The association between stress and headache: a longitudinal population-based study. Cephalalgia. 2015;35:853–63.

    Article  PubMed  Google Scholar 

  32. Westergaard M, Glümer C, Hansen E, Jensen R. Medication overuse, healthy lifestyle behaviours and stress in chronic headache: results from a representative population-based survey. Cephalalgia. 2016;36:15–28.

    Article  PubMed  Google Scholar 

  33. Cevoli S, Sancisi E, Grimaldi D, Pierangeli G, Zanigni S, Nicodemo M, et al. Family history for chronic headache and drug overuse as a risk factor for headache chronification. Headache. 2009;48:412–8.

    Article  Google Scholar 

  34. Silberstein S, Tfelt-Hansen P, Dodick DW, Limmroth V, Lipton RB, Pascual J, et al. Guidelines for controlled trials of prophylactic treatment of chronic migraine in adults. Cephalalgia. 2008;28:484–95.

    Article  CAS  PubMed  Google Scholar 

  35. Zeeberg P, Olesen J, Jensen R. Discontinuation of medication overuse in headache patients: recovery of therapeutic responsiveness. Cephalalgia. 2006;26:1192–8.

    Article  CAS  PubMed  Google Scholar 

  36. Chiang C, Schwedt T, Wang S, Dodick D. Treatment of medication-overuse headache: a systematic review. Cephalalgia. 2016;36:371–86.

    Article  PubMed  Google Scholar 

  37. Krymchantowski AV, Moreira PF. Outpatient detoxification in chronic migraine: comparison of strategies. Cephalalgia. 2003;23:982–93.

    Article  CAS  PubMed  Google Scholar 

  38. Rossi P, Di Lorenzo C, Faroni J, Cesarino F, Nappi G. Advice alone vs structured detoxification programmes for medication overuse headache: a prospective, randomized, open-label trial in transformed migraine patients with low medical needs. Cephalalgia. 2006;26:1097–110.

    Article  CAS  PubMed  Google Scholar 

  39. •• Tassorelli C, Jensen R, Allena M, De Icco R, Sances G, Katsarava Z, et al, Nappi G; the COMOESTAS Consortium. A consensus protocol for the management of medication-overuse headache: evaluation in a multicentric, multinational study. Cephalalgia 2014;34:645–655. This study we defined and tested a consensus protocol for the management of MOH on a large population of patients distributed in different countries.

  40. Kristoffersen ES, Straand J, Vetvik KG, Benth JŠ, Russell MB, Lundqvist C. Brief intervention for medication-overuse headache in primary care. The BIMOH study: a double-blind pragmatic cluster randomised parallel controlled trial. J Neurol Neurosurg Psychiatry. 2015;86:505–12.

    Article  PubMed  Google Scholar 

  41. Andrasik F, Grazzi L, Usai S, Buse DC, Bussone G. Non-pharmacological approaches to treating chronic migraine with medication overuse. Neurol Sci. 2009;30:S89–93.

    Article  PubMed  Google Scholar 

  42. Rausa M, Palomba D, Cevoli S, Lazzerini L, Sancisi E, Cortelli P, et al. Biofeedback in the prophylactic treatment of medication overuse headache: a pilot randomized controlled trial. J Headache Pain. 2016;17:87.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Krymchantowski AV, Barbosa JS. Prednisone as initial treatment of analgesic-induced daily headache. Cephalalgia. 2000;20:107–13.

    Article  CAS  PubMed  Google Scholar 

  44. Pageler L, Katsarava Z, Diener HC, Limmroth V. Prednisone versus placebo in withdrawal therapy following medication overuse headache. Cephalalgia. 2008;28:152–6.

    CAS  PubMed  Google Scholar 

  45. Krymchantowski AV, Tepper SJ, Jevoux C, Valença M. Medication-overuse headache: protocols and outcomes in 149 consecutive patients in a tertiary Brazilian headache center. Headache. 2017;57:87–96.

    Article  PubMed  Google Scholar 

  46. Bøe MG, Mygland A, Salvesen R. Prednisolone does not reduce withdrawal headache. Neurology. 2007;69:26–31.

    Article  PubMed  Google Scholar 

  47. Grazzi L, Andrasik F, Usai S, Bussone G. In-patient vs. day-hospital withdrawal treatment for chronic migraine with medication overuse and disability assessment: results at one-year follow-up. Neurol Sci. 2008;29:161–3.

    Article  Google Scholar 

  48. Saper J, Lake A III. Medication overuse headache: type I and type II. Cephalalgia. 2006;26:1262.

    Article  CAS  PubMed  Google Scholar 

  49. Valguarnera F, Tanganelli P. The efficacy of withdrawal therapy in subjects with chronic daily headache and medication overuse following prophylaxis with topiramate and amitriptyline. Neurol Sci. 2010;31:S175–7.

    Article  PubMed  Google Scholar 

  50. Trucco M, Meineri P, Ruiz L, Gionco M, Gruppo Neurologico Ospedaliero Interregionale per lo Studio delle Cefalee (Neurological Hospital Interregional Group for the Study of Headaches). Medication overuse headache: withdrawal and prophylactic therapeutic regimen. Headache. 2010;50:989–97.

    Article  PubMed  Google Scholar 

  51. Rossi P, Faroni JV, Nappi G. Medication overuse headache: predictors and rates of relapse in migraine patients with low medical needs. A 1-year prospective study. Cephalalgia. 2008;28:1196–200.

    Article  CAS  PubMed  Google Scholar 

  52. Schnider P, Aull S, Baumgartner C, Marterer A, Wöber C, Zeiler K, et al. Long-term outcome of patients with headache and drug abuse after inpatient withdrawal: five-year follow-up. Cephalalgia. 1996;16:481–5.

    Article  CAS  PubMed  Google Scholar 

  53. Evers S, Suhr B, Bauer B, Grotemeyer KH, Husstedt IW. A retrospective long-term analysis of the epidemiology and features of drug-induced headache. J Neurol. 1999;248:802–9.

    Article  Google Scholar 

  54. Fritsche G, Eberl A, Katsarava Z, Limmroth V, Diener HC. Drug-induced headache: long-term follow-up of withdrawal therapy and persistence of drug misuse. Eur Neurol. 2001;45:229–35.

    Article  CAS  PubMed  Google Scholar 

  55. Pini LA, Cicero AF, Sandrini M. Long-term follow-up of patients treated for chronic headache with analgesic overuse. Cephalalgia. 2001;21:878–83.

    Article  CAS  PubMed  Google Scholar 

  56. Katsarava Z, Muessig M, Dzagnidze A, Fritsche G, Diener HC, Limmroth V. Medication overuse headache: rates and predictors for relapse in a 4-year prospective study. Cephalalgia. 2005;25:12–5.

    Article  CAS  PubMed  Google Scholar 

  57. Hagen K, Albretsen C, Vilming ST, Salvesen R, Gronning M, Helde G, et al. A 4-year follow-up of patients with medication-overuse headache previously included in a randomized multicenter study. J Headache Pain. 2011;12:315–22.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Zidverc-Trajkovic JJ, Pekmezovic T, Jovanovic Z, Pavlovic A, Mijajlovic M, Radojicic A, Sternic N. Long-term predictors of remission in patients treated for medication-overuse headache at a specialized headache center: a prospective cohort study. Cephalalgia 2016 9.

  59. Raggi A, Giovannetti AM, Leonardi M, Sansone E, Schiavolin S, Curone M, et al. Predictors of 12-months relapse after withdrawal treatment in hospitalized patients with chronic migraine associated with medication overuse: a longitudinal observational study. Headache. 2017;57:60–70.

    Article  PubMed  Google Scholar 

  60. Boe MG, Salvesen R, Mygland A. Chronic daily headache with medication overuse: predictors of outcome 1 year after withdrawal therapy. Eur J Neurol. 2009;16:705–12.

    Article  CAS  PubMed  Google Scholar 

  61. Negro A, Curto M, Luana L, Giamberardino MA, Martelletti P. Chronic migraine treatment: from onabotulinumtoxinA onwards. Expert Rev Neurother. 2016;16:1217–27.

    Article  CAS  PubMed  Google Scholar 

  62. Guerzoni S, Pellesi L, Baraldi C, Pini LA. Increased efficacy of regularly repeated cycles with onabotulinumtoxinA in MOH patients beyond the first year of treatment. J Headache Pain. 2016;17:48.

    Article  PubMed Central  Google Scholar 

  63. Aicua-Rapun I, Martínez-Velasco E, Rojo A, Hernando A, Ruiz M, Carreres A, et al. Real-life data in 115 chronic migraine patients treated with onabotulinumtoxinA during more than one year. J Headache Pain. 2016;17:112.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Negro A, Curto M, Lionetto L, Crialesi D, Martelletti P. OnabotulinumtoxinA 155 U in medication overuse headache: a two years prospective study. Spring. 2015;4:826.

    Article  Google Scholar 

  65. •• Negro A, Curto M, Lionetto L, Martelletti P. A two years open-label prospective study of onabotulinumtoxinA 195 U in medication overuse headache: a real-world experience. J Headache Pain. 2015;17:1. This is the largest and longest postmarketing study of doses comparison with onabotulinumtoxinA in a real-life clinical setting for CM patients with MOH.

    Article  PubMed  Google Scholar 

  66. Láinez MJ, Freitag FG, Pfeil J, Ascher S, Olson WH, Schwalen S. Time course of adverse events most commonly associated with topiramate for migraine prevention. Eur J Neurol. 2007;14:900–6.

    Article  PubMed  Google Scholar 

  67. Diener HC, Bussone G, Van Oene JC, Lahaye M, Schwalen S, TOPMAT-MIG-201(TOP-CHROME) Study Group, et al. Topiramate reduces headache days in chronic migraine: a randomized, double-blind, placebo-controlled study. Cephalalgia. 2007;27:814–23.

    Article  PubMed  Google Scholar 

  68. NICE; Botulinum toxin type A for the prevention of headaches in adults with chronic migraine; Technology appraisal guidance [TA260]; https://www.nice.org.uk/guidance/ta260. Last accessed 13 March 2017.

  69. Shuhendler AJ, Lee S, Siu M, Ondovcik S, Lam K, et al. Efficacy of botulinum toxin type A for the prophylaxis of episodic migraine headaches: a meta-analysis of randomized, double-blind, placebo-controlled trials. Pharmacotherapy. 2009;29:784–91.

    Article  CAS  PubMed  Google Scholar 

  70. Aurora SK, Gawel M, Brandes JL, Pokta S, Vandenburgh AM, BOTOX North American Episodic Migraine Study Group. Botulinum toxin type a prophylactic treatment of episodic migraine: a randomized, double-blind, placebo-controlled exploratory study. Headache. 2007;47:486–99.

    Article  PubMed  Google Scholar 

  71. Linde M, Gustavsson A, Stovner LJ, Steiner TJ, Barré J, Katsarava Z, et al. The cost of headache disorders in Europe: the Eurolight project. Eur J Neurol. 2012;19:703–11.

    Article  CAS  PubMed  Google Scholar 

  72. Munksgaard SB, Bendtsen L, Jensen RH. Treatment-resistant medication overuse headache can be cured. Headache. 2012;52:1120–9.

    Article  PubMed  Google Scholar 

  73. Schramm S, Uluduz D, Gouveia RG, Jensen R, Siva A, Uygunoglu U, et al. Headache service quality: evaluation of quality indicators in 14 specialist-care centres. J Headache Pain. 2016;17:111.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Lipton RB, Munjal S, Buse DC, Fanning KM, Bennett A, Reed ML. Predicting inadequate response to acute migraine medication: results from the American Migraine Prevalence and Prevention (AMPP) study. Headache. 2016;56:1635–48.

    Article  PubMed  Google Scholar 

  75. • Giamberardino MA, Affaitati G, Curto M, Negro A, Costantini R, Martelletti P. Anti-CGRP monoclonal antibodies in migraine: current perspectives. Intern Emerg Med. 2016;11:1045–57. An up-to-date current review on the newest treatments for the primary headache disorders.

    Article  PubMed  Google Scholar 

  76. Silberstein SD, Blumenfield AM, Cady RK, Turner IM, Lipton RB, Deiner HC, et al. OnabotulinumtoxinA for treatment of chronic migraine: PREEMPT 24-week pooled subgroup analysis of patients who had acute headache medication overuse at baseline. J Neurol Sci. 2013;331:48–56.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy

    Andrea Negro MD & Paolo Martelletti MD, Prof.

  2. Regional Referral Headache Centre, Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00191, Rome, Italy

    Andrea Negro MD & Paolo Martelletti MD, Prof.

  3. Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy

    Martina Curto MD, PhD

  4. Advanced Molecular Diagnostics Unit, IDI Istituto Dermopatico dell’Immacolata - IRCSS, Rome, Italy

    Luana Lionetto PhD

  5. Department of Diagnostic and Clinical Medicine and Public Health, Proteomic Lab, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy

    Simona Guerzoni MD & Luigi Alberto Pini MD, Prof.

Authors
  1. Andrea Negro MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Martina Curto MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luana Lionetto PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Simona Guerzoni MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luigi Alberto Pini MD, Prof.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Paolo Martelletti MD, Prof.
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Andrea Negro, Martina Curto, Luana Lionetto, and Simona Guerzoni participated in the search of the background literature and writing of the paper.

Andrea Negro, Simona Guerzoni, Luigi Alberto Pini, and Paolo Martelletti participated in the conception and critical discussion of the paper.

All authors approved the final draft.

Corresponding author

Correspondence to Andrea Negro MD.

Ethics declarations

Conflict of Interest

Martina Curto and Luana Lionetto declare that they have no conflict of interest.

Andrea Negro received travel grants, honoraria, and participated in the advisory board of Allergan and Electrocore.

Simona Guerzoni participated in the advisory board of Allergan.

Luigi Alberto Pini participated in the advisory board of Allergan and Mylan.

Paolo Martelletti received travel grants, honoraria, and consultancy, and participated in the advisory boards of Allergan and Teva.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Headache

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Negro, A., Curto, M., Lionetto, L. et al. A Critical Evaluation on MOH Current Treatments. Curr Treat Options Neurol 19, 32 (2017). https://doi.org/10.1007/s11940-017-0465-2

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11940-017-0465-2

Keywords

Search

Navigation