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Evidence from clinical trials and real-world studies shows comparable efficacy regardless of prior detoxification, with natural reductions in acute medication use as migraine frequency declines. Safety analyses also support favorable tolerability when CGRP mAbs are combined with acute drugs, potentially improving adherence and reducing withdrawal complications.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/calcitonin-gene-related-peptide-monoclonal-antibodies-and-medication-overuse-headache-is-stopping-excessive-pain-medication-still-necessary/435869/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/calcitonin-gene-related-peptide-monoclonal-antibodies-and-medication-overuse-headache-is-stopping-excessive-pain-medication-still-necessary/435869.png","ImageObject",300,407,{"name":92,"@type":93},"Himbo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",11,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is the traditional detoxification approach for medication overuse headache being questioned?","Question",{"text":113,"@type":114},"Emerging clinical trial and real-world evidence suggests CGRP monoclonal antibodies can improve migraine and MOH outcomes without requiring mandatory discontinuation of overused analgesics beforehand.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What benefits do CGRP mAbs show for patients with MOH compared with forced withdrawal?",{"text":118,"@type":114},"Patients receiving CGRP mAb therapy can achieve similar efficacy, experience reductions in headache days and symptomatic medication intake, and may transition from MOH to non-MOH without detox protocols.",{"name":120,"@type":111,"acceptedAnswer":121},"How do safety findings relate to combining CGRP mAbs with acute pain medications?",{"text":122,"@type":114},"Safety analyses indicate favorable tolerability profiles when CGRP mAbs are administered concurrently with various acute medications, supporting a more flexible, individualized treatment strategy.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},435869,1790876542,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":39,"preview_page_count":4},687197100911,"https://ap-avatar.wpscdn.com/avatar/a000239b6f1da00475?x-image-process=image/resize,m_fixed,w_180,h_180&k=1785132997149421697","Article published online: 2025-07-28  \nPoint of View 1  \nCalcitonin gene-related peptide monoclonal antibodies and medication overuse headache: is stopping excessive pain medication still necessary?  \nJoão José Freitas de Carvalho 1  \n1 Faculdade de Medicina Unichristus, Fortaleza CE, Brazil. Arq. Neuro-Psiquiatr. 2025;83(9):s00451809658 .  \nAddress for correspondence João José Freitas de Carvalho (email: [jjcarvalho@gmail.com](jjcarvalho@gmail.com))  \nAbstract  \nKeywords  \n► Headache  \n► Headache Disorders, Secondary  \n► Migraine Disorders  \n► Tension-Type Headache  \n► Therapeutics  \n► Analgesics  \nRecent studies demonstrate a significant paradigm shift concerning migraine patients suffering from medication overuse (MO) . Traditionally, doctors used to demand that patients who overused medications be withdrawn before beginning any preventive therapy; however, such a belief has recently been challenged by emerging evidence about the benefit of calcitonin gene-related peptide monoclonal antibodies (CGRPmAbs), which have shown similar effectiveness in several clinical trials and real-world studies, regardless of whether a patient has previously stopped taking excessive medications. The data indicates that patients undergoing CGRP mAb therapy naturally decreased their acute medication consumption as migraine frequency diminished without requiring forced discontinuation. Furthermore, safety analyses have confirmed favorable tolerability profiles when CGRP mAbs are administered concurrently with various acute medications. This new evidence-based approach offers several clinical advantages, including enhanced treatment adherence and reduced risk of withdrawal complications. These findings support transitioning from mandatory detoxification protocols toward more individualized treatment strategies, representing a significant advancement in clinical migraine management.  \nINTRODUCTION  \nConcomitant medication overuse (MO) and medication overuse headache (MOH) classically represent a significant challenge in migraine treatment. The management of these patients has traditionally centered on discontinuation of overused medications concurrent with initiating preventive therapy. However, the advent of calcitonin gene-related  \nThis article is part of a debate series on Headache and Pain (CGRPMonoclonal Antibodies for Migraine), featuring different perspectives. Check out the other points of view: [https://doi.org/10.1055/s-](https://doi.org/10.1055/s-)[ ](https://doi.org/10.1055/s-)0045-1809333 and [https://doi.org/10.1055/s-0045-1809332](https://doi.org/10.1055/s-0045-1809332).  \npeptide monoclonal antibodies (CGRP mAbs) has challenged this established paradigm. In recent years, a growing body of evidence suggests that these innovative therapeutics can effectively treat migraine prophylaxis without requiring prior analgesic discontinuation, representing a significant shift in our approach and management. This sems to be apharmacological class effect as randomized clinical trials (RCTs) and real-world studies demonstrated similar efficacyand tolerability of all these new medicines in chronic (CM) and episodic migraine (EM), regardless of medication overuse (MO) and various previous treatment failures.1  \nreceived  \nFebruary 11, 2025 received in its final form March 04, 2025  \naccepted  \nMarch 9, 2025  \nDOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1809658 . ISSN 0004-282X.  \nEditor-in-Chief: Hélio A. G. Teive.  \nAssociate Editor: Carlos Henrique Ferreira Camargo.  \nGuest Editor: Pedro Augusto Sampaio Rocha Filho.   \n© 2025 . The Author(s) .  \nThis is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/))  \nThieme Revinter Publicações Ltda. , Rua Rego Freitas, 175, loja 1","cbCaih1S9IHW3RoI","https://ap.wps.com/l/cbCaih1S9IHW3RoI","pdf",329598,"English","# Abstract\n# Introduction\n# Clinical efficacy without prior detoxification\n## Comparative and multicenter evidence\n# Real-world evidence\n# Received and publication details","[{\"question\":\"Why is the traditional detoxification approach for medication overuse headache being questioned?\",\"answer\":\"Emerging clinical trial and real-world evidence suggests CGRP monoclonal antibodies can improve migraine and MOH outcomes without requiring mandatory discontinuation of overused analgesics beforehand.\"},{\"question\":\"What benefits do CGRP mAbs show for patients with MOH compared with forced withdrawal?\",\"answer\":\"Patients receiving CGRP mAb therapy can achieve similar efficacy, experience reductions in headache days and symptomatic medication intake, and may transition from MOH to non-MOH without detox protocols.\"},{\"question\":\"How do safety findings relate to combining CGRP mAbs with acute pain medications?\",\"answer\":\"Safety analyses indicate favorable tolerability profiles when CGRP mAbs are administered concurrently with various acute medications, supporting a more flexible, individualized treatment strategy.\"}]","Calcitonin gene-related peptide monoclonal antibodies and medication overuse headache - is stopping excessive pain medication still necessary? | PDF",1790675668]