Accordingly, patients with CM with acute medication overuse should be treated with optimal prevention, and the evidence is strongest for use of the mAbs to both reduce mean monthly migraine days and all acute medication use, both triptans and analgesics. The new monoclonal antibody effectiveness may make the old arguments moot.
Hans-Christoph Diener, MD, PhD
University of Essen, Germany
I think no one doubts that MOH exists. The worldwide prevalence is between 1% and 2% ( Table). The dilemma is that the diagnosis can only be made after the intake of acute medication has been reduced. There are confounders: migraine can improve irrespective of the reduction of acute medication and many physicians will implement migraine prevention at the time of withdrawal. No randomized trial compared the continuation of unchanged intake of medication to treat migraine attacks with reduction or withdrawal.
| Author (year) (reference) | Country | Age Group | Prevalence of MOH |
Castillo et al. (1999) 7 | Spain | ≥ 14 | 1,2% |
Wang et al. (2000) 8 | Taiwan | ≥ 65 | 1,0% |
Lu et al. (2001) 9 | Taiwan | ≥ 15 | 1,1% |
Pascual et al. (2001) 10 | Review | 1,0-1,9% | |
Prencipe et al. (2001) 11 | France | ≥ 65 | 1,7% |
Colas et al. (2004) 12 | Spain | ≥ 14 | 1,5% |
Zwart et al. (2004) 13 | Norway | ≥ 20 | 0,9-1,0% |
Dyb et al. (2006) 14 | Norway | 13-18 | 0,2% |
Wang et al. (2006) 15 | Taiwan | 12-14 | 0,3% |
Wiendels (2006) 16 | Netherlands | 25-55 | 2,6% |
Stovner et al.(2007) 17 | Review | 0,5-1,0% | |
Aaseth et al. (2008, 2009) 18,19 | Norway | 30-44 | 1,7% |
Rueda-Sanchez & Diaz-Martinez (2008) 20 | Columbia | 18-65 | 4,5% |
Katsarava et al. (2009) 21 | Georgia | ≥ 16 | 0,9% |
Da Silva et al. (2009) 22 | Brazil | 10-93 | 1,6% |
Straube et al. (2010) 23 | Germany | 18-88 | 1,0% |
Jonsson et al. (2011, 2012) 24,25 | Sweden | ≥ 15 | 1,8% |
Linde et al. (2011) 26 | Norway | ≥ 20 | 1,0% |
Lipton et al. (2011) 27 | USA | 12-17 | 1,0% |
Ayzenberg et al. (2012) 28 | Russia | 18-65 | 7,2% |
Ertas et al. (2012) 29 | Turkey | 18-65 | 2,1% |
Hagen et al. (2012) 30 | Norway | ≥ 20 | 0,8% |
Yu et al. (2012) 31 | China | 18-65 | 0,9% |
Shahbeigi et al. (2013) 32 | Iran | ≥ 10 | 4,9% |
Schramm et al. (2013) 33 | Germany | 18-65 | 0,7% |
Park et al. (2014) 34 | South Korea | 19-69 | 0,5% |
Kristoffersen & Lundqvist (2014) 35 | Multinational summary | 1,0-2,0% | |
Steiner (2014) 36 | Multinational summary | 1,0-2,0% | |
Westergaard et al. (2015) 37 | Denmark | 0,5-7,2% | |
Bravo (2015) 38 | Multinational | Older | 1,0-7,1% |
Mbewe et al. (2015) 39 | Zambia | 18-65 | 12,7% (adj. 7,1%) |
Kulkarni et al. (2015) 40 | India | 18-65 | 1,2% |
Westergaard et al. (2016) 41 | Denmark | ≥ 16 | 1,6% (adj. 1,8%) |
Manandhar et al. (2016) 42 | Nepal | 18-65 | 2,2% |
Zebenigus et al. (2016) 43 | Ethiopia | 18-65 | 0,8% (adj. 0,7%) |
Al-Hashel et al. (2017) 44 | Kuwait | 18-65 | 2,4% |
Rastenyte et al. (2017) 45 | Lithuania | 18-65 | 3,5% (adj. 3,2%) |
Henning et al. (2018) 46 | Germany | 18-65 | 0,7% |
Global Burden of Disease 2017 47 | Global | 0,8% |
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Commentary by Alan M. Rapoport, MD