Celecoxib vs prednisone for the treatment of withdrawal headache in patients with medication overuse headache: a randomized, double-blind clinical trial.

Objective To compare the efficacy of celecoxib for treatment of withdrawal headache vs prednisone in patients with medication overuse headache (MOH). Methods In this prospective, double-blind, parallel-group clinical trial, 97 consecutive subjects with MOH were randomized (simple randomization using computer-generated numbers) for treatment with either 400 mg/day celecoxib (for the first 5 days then decreased at a rate of 100 mg every 5 days) or prednisone 75 mg/day orally (for the first 5 days then tapered off every 5 days). Subjects who met the International Headache Society criteria for MOH were included in the trial. The change in headache days and intake of rescue medication were considered as primary outcomes while the change in headache severity defined as a secondary outcome. Results Patients treated with celecoxib experienced lower headache intensity during the first 3 weeks after withdrawal (after 3 weeks, the median of visual analog scale was 3 for patients in celecoxib group vs 4.5 for prednisone group [P < .001]). However, headache frequency and the need for rescue medication intake were not different between 2 groups. Conclusion During withdrawal in MOH, in order to reduce headache days or rescue medication intake, using either of celecoxib or prednisone as a bridge is not different.