Medication-overuse headache: can anti-CGRP monoclonal antibodies replace withdrawal?

INTRODUCTION

Medication-overuse headache (MOH) is a secondary headache disorder arising from the excessive use of acute headache medications, most commonly triptans and nonsteroidal anti-inflammatory drugs (NSAIDs). Traditional management relies on education strategies and drug withdrawal followed by preventive therapy, but relapse rates remain high and detoxification is not always feasible.

AREAS COVERED: This review summarizes current evidence on anti-calcitonin gene-related peptide (CGRP) monoclonal antibodies in migraine patients with medication overuse or MOH. A structured literature search was conducted in PubMed and Scopus for studies published up to August 2025. Erenumab, fremanezumab, galcanezumab and eptinezumab consistently reduced headache frequency, acute medication intake and disability, even when initiated without prior withdrawal of overused drugs. Rates of remission from MOH to non-overuse status were high, and safety profiles were comparable to those observed in general migraine populations.

EXPERT OPINION: Anti-CGRP antibodies offer a targeted strategy capable of interrupting the cycle of overuse and sensitization underlying MOH. Early initiation of anti-CGRP therapy during ongoing overuse appears effective and well tolerated, but long-term outcomes are likely improved when treatment is accompanied by patient education and, in selected cases, structured withdrawal.