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The debate frames MOH care in the era of monoclonal antibodies targeting the CGRP pathway, emphasizing that different patient subgroups may benefit from different individualized strategies. Approaches include immediate or delayed prophylaxis, optional bridging therapy, and recommending either immediate cessation or gradual reduction of medication overuse, aiming for sustained improvement.",{"@graph":69,"@context":122},[70,84,105],{"@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/in-the-era-of-monoclonal-antibodies-targeting-the-calcitonin-gene-related-peptide-pathway-is-it-still-necessary-to-stop-taking-excessive-pain-medication-medication-overuse-headache-moh-debate-point-of-view/435859/",{"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/in-the-era-of-monoclonal-antibodies-targeting-the-calcitonin-gene-related-peptide-pathway-is-it-still-necessary-to-stop-taking-excessive-pain-medication-medication-overuse-headache-moh-debate-point-of-view/435859.png","ImageObject",300,407,{"name":92,"@type":93},"Himbo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":14},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is medication-overuse headache (MOH) and why does it remain difficult to manage?","Question",{"text":112,"@type":113},"MOH is described as a condition linked to excessive use of pain medication. It remains challenging because management requires sustained improvement, and many patients experience persistent or recurrent symptoms even after medical care.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the CGRP monoclonal antibody era change MOH treatment considerations?",{"text":117,"@type":113},"Studies of anti-CGRP monoclonal antibodies suggest potential improvement for patients who cannot stop medication overuse on their own. 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Neuro-Psiquiatr. 2025;83(9):s00451809333 .  \nAddress for correspondence Renata Gomes Londero (email: [rlondero@hcpa.edu.br](rlondero@hcpa.edu.br))  \nAbstract  \nKeywords  \n► Headache Disorders, Secondary  \n► Antibodies, Monoclonal  \n► Eptinezumab  \n► Galcanezumab  \n► Fremanezumab  \nMedication-overuse headache (MOH) was first described in 1951 with ergotamine overuse. Since then, much has been studied about its risk factors, pathophysiology, prevention, and treatment. Despite this, many people still suffer from this condition. Even for those who reach medical care, the path to maintaining significant improvement is neither short nor easy. Here, we propose the ubiquitous individualization of headache treatment. The more we study the condition, the more it becomes evident that different groups of patients benefit from different approaches: starting prophylactic medication immediately or postponing it, providing a bridge treatment or not, and advising patients to either stop medication overuse immediately or reduce it gradually.  \nMedication overuse headache (MOH) was first described by Peters and Horton in 1951, with ergotamine-overuse.1 Since then, much has been described about risk factors, pathophysiology, prevention, and treatment. Described in the International Classification of Headache Disorders-3 (ICHD-3), MOH continues to be a challenge in terms of management, even in the era ofmonoclonal antibodies targeting the calcitonin generelated peptide (anti-CGRP mAbs).  \nIn the present study, we propose the ubiquitous individualization of headache treatment. Why is it that the more we study the condition, the more we observe that different groups of patients benefit from different approaches? As in  \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/](https://doi.org/10.1055/)[ ](https://doi.org/10.1055/)s-0045-1809332 and [https://doi.org/10.1055/s-0045-1809658](https://doi.org/10.1055/s-0045-1809658).  \nreceived  \nFebruary 11, 2025 received in its final form February 28, 2025 accepted  \nMarch 7, 2025  \nDOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1809333 . ISSN 0004-282X.  \nEditor-in-Chief: Hélio A. G. Teive.  \nAssociate Editor: Carlos Henrique Ferreira Carmago.  \nGuest Editor: Pedro Augusto Sampaio Rocha Filho.   \nmany areas, it is possible to individualize procedures and offer each patient a greater chance of success.  \nRecent studies show us immediate success rates of15to40%  \n2,3 in reducing days with headache and use of rescue medication in patients with chronic migraine and MOH between the different forms of management proposed. For many of those patients (20–40%)4,5 MOH recurs after12 months, in studies that look for those data. Studies of anti-CGRP MAbs raised the possibility of improving patients who were unable to stop MOH on their own. A real-world analysis showed that 60.6% of patients with chronic migraine and MOH had their symptoms resolved after treatment with CGRP antibodies. However, 40% of them did not improve, which can have many explanations.  \nIt has already been observed that the motivation to take pills to treat headache vary in different patients, including relief for pain, fear of having a flare-up after being exposed to conditions known to trigger pain, fear of having a crisis at an  \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 t","cbCaitobwyMLuX4l","https://ap.wps.com/l/cbCaitobwyMLuX4l","pdf",223505,"English","# Medication-overuse headache and individualized management\n## MOH background, risk factors, and ongoing challenge\n## Treatment individualization in the era of anti-CGRP monoclonal antibodies\n## Bridging, stopping vs gradual reduction, and long-term outcomes","[{\"question\":\"What is medication-overuse headache (MOH) and why does it remain difficult to manage?\",\"answer\":\"MOH is described as a condition linked to excessive use of pain medication. It remains challenging because management requires sustained improvement, and many patients experience persistent or recurrent symptoms even after medical care.\"},{\"question\":\"How does the CGRP monoclonal antibody era change MOH treatment considerations?\",\"answer\":\"Studies of anti-CGRP monoclonal antibodies suggest potential improvement for patients who cannot stop medication overuse on their own. However, not all patients improve, indicating that response varies.\"},{\"question\":\"What individualized strategies are proposed for MOH management?\",\"answer\":\"The discussion proposes tailoring headache treatment by starting prophylactic medication immediately or postponing it, considering or not considering bridging therapy, and advising patients to stop medication overuse immediately or reduce it gradually.\"}]","In the era of monoclonal antibodies targeting the calcitonin gene-related peptide pathway, is it still necessary to stop taking excessive pain medication - Medication overuse headache (MOH) debate point of view | PDF",1790675585]