Frovatriptan as a Transitional Therapy in Medication Overuse Headache

Inclusion Criteria:

• MOH diagnosed by IHS criteria
• Diagnosis of migraine (with or without aura) in past by IHS criteria
• If patients do not have a baseline diary, then a prospective diary for a 10-day period will be done to confirm medication overuse before study entry.
• Patients aged 18 to 65 years.
• Normal neurological examination.
• Patient is willing and able (in terms of capacity) to sign informed consent.
• Patient is able to understand and complete study protocol, including completion of headache diaries.
• Patient has a stable medical condition.

Exclusion Criteria:

• Headache not meeting IHS criteria for MOH.
• Presence of hemiplegic, basilar, ophthalmoplegic migraine or migrainous infarction.
• Findings on history, neurological exam, or neuroimaging suggestive of secondary causes of headache.
• Post-whiplash or post-traumatic headaches.
• Contraindications to triptans (such as heart disease, peripheral vascular disease or uncontrolled hypertension) or previous serious side effects/intolerance.
• Major psychiatric conditions (such as major depression, bipolar disorder, schizophrenia, addiction), either diagnosed by a physician or positive on standard clinic assessment tools (e.g. BDI questionnaire).
• Major medical conditions or treatments that may interfere with the patient's ability to participate in the study, such as dementia, advanced or terminal cancer, chemotherapy, etc.
• Patient is pregnant, breastfeeding, or is expecting to conceive within the time period of the study. Pregnancy will be determined using a urine test.
• Women of childbearing potential who are not using a reliable method of contraception.
• Patient is a recent user of illicit/recreational drugs or plans to use illicit drugs during the study time period.
• Patient has a recent history of alcohol abuse or dependence, or plans to abuse alcohol during the study duration.
• Patient is unlikely to comply with the study protocol, keep diaries and appointments, or does not have a fixed telephone or address.
• Patient is enrolled in another study or trial that may interfere with their participation or the results of this study.
• Patients with greater than 30% of their data missing during the ten days of baseline diary data collection.
• Patients with mean headache intensities of less than 3 (from a pain scale of 0 to 10, where 0=no pain and 10=pain as bad as possible) during the 10-day baseline period.
• Patients with ongoing Botox treatments or those who have received Botox in the last 4 months.