Detoxification for medication overuse headache is the primary task.

BACKGROUND Common practice in patients overusing medication is to place major emphasis on detoxification. OVERVIEW This is based on decades of disappointing experience trying to treat patients with prophylactics despite medication overuse. Several trials have shown that, when patients are taken off medication overuse, approximately 50% of them get so much better that prophylactic drug treatment is no longer needed. There is no doubt that detoxification by one means or another is of crucial importance in the initial steps of treating patients who have a medication overuse. The methodology for detoxification may vary from country to country. Likewise, it varies whether patients are placed on prophylactic treatment simultaneously with detoxification or after a drug-free period of 2 months. Only future long-term studies can show whether one approach or the other is preferable. CONCLUSION Detoxification must always be the first consideration in overusing patients, but obviously accompanied by or followed up by the necessary prophylactic or treatment.