Nineteen studies were included in the review, 3 randomised controlled trials (RCTs), 2 controlled trials, 12 uncontrolled trials, 1 retrospective study and 1 case series.
Abrupt discontinuation of analgesics (n=6):
1 randomised trial, 3 groups, results at 4 weeks (improvement in headache index, HI): abrupt discontinuation, 60% improvement; amitriptyline added, 24% improvement; abrupt discontinuation with addition of amitriptyline, 72% improvement.
1 controlled trial, 5 groups. Results at 12 week (improvement in HI): continued medication, 24% improvement; symptomatic medications abruptly stopped, 58% improvement; symptomatic medications abruptly stopped and prophylactic medication started, 85% improvement; symptomatic medications abruptly stopped and prophylactic medication continued, 72% improvement; symptomatic medications abruptly stopped and prophylactic dose or drug changed 85% improvement.
3 uncontrolled trials, 2 abrupt discontinuation and 1 abrupt withdrawal and addition of beta-blocker or tricyclic antidepressant, all found improvement in patients compared to baseline: 45% headache free on discharge in one trial, 50% had <8 headaches per month in second trial and in trial with additional treatment all groups showed improvement ranging from 24-85% improvement in HI. One case series (5 subjects), abrupt withdrawal, all had cessation of daily headaches within 5 days.
Non-steroidal anti-inflammatory drugs (NSAIDS)(n=4):
1 RCT. Medication withdrawn and naproxen (500 mg po bid) versus symptomatic medications, at 8 days there were less headaches in naproxen group over the 8 d, no difference in HI between the groups. 3 uncontrolled trials, all abrupt withdrawal together with NSAIDs (naproxefen 500 mg po prn + amitriptyline; tolfenamic acid 200mg po tid + chlordiazepoxide 10-25mg po tid; naproxefen 500 mg/d iv, delorazepam 2mg/d iv, pridinol 2mg/d iv), all showed some improvement (80%, 62% and not stated).
Methylergonovine (n=1):
1 uncontrolled trial, showed that after 6 months 43% rated headache as much better, 30% rated as better and 20% unchanged.
Dihydroergotamine (DHE)(n=3):
1 controlled trial, patients received either DHE + proprananol or diazepam, 89% of DHE patients and 13% diazepam patients H/A free at 48 hours, at 16 months 65% DHE patients had good/excellent response 1 retrospective study, rapid withdrawal + DHE + metoclopramied, 92% became headache free, most within 48 hours. 1 uncontrolled trial (3 patients), no overall improvements.
Sumatriptan (n=1):
Same authors report on RCT and uncontrolled trial. Uncontrolled trial showed brief benefit in migraine experiencers, none in non-migraine. In RCT all sumatriptan-treated patients had complete resolution of headache for 6-12 hours versus none in placebo.
Amitriptyline and deamethasone (n=1):
1 uncontrolled trial. At 6 months 61% very good responders, 39% responders.
Prothopendyl and piracetam (n=1):
1 uncontrolled trial. 90% headache free at discharge, 61% had significant relief at 17 months, 24% had no reduction in headache or medication use.
Valproic acid (n=1):
1 uncontrolled trial. 48% had >75% reduction in HI.