An exploration of possible future non-pharmacological multidisciplinary treatments to potentiate withdrawal strategy and recovery from medication overuse headache (MOH): a narrative review

Medication Overuse Headache (MOH) is a secondary headache resulting from the sustained overuse of acute headache medications, and represents a clinical challenge for its complex pathophysiology and high relapse rate. This narrative review examines non-pharmacological strategies for the management of MOH, and explores the potential role of a multidisciplinary approach in improving patient outcomes. The available evidence on patient education, psychotherapy, behavioral interventions, physical therapy, and neuromodulation techniques was reviewed, along with other non-pharmacological approaches, such as dietary modifications, Ayurveda, and acupuncture. These interventions may help in targeting multiple dimensions of MOH pathophysiology, and could be tailored to individual patient needs. Integrating multimodal non-pharmacological interventions with medication withdrawal and, when appropriate, bridging therapies appears promising in improving outcomes and reducing the overall burden of MOH. However, further research is required to identify the optimal combination and duration of multidisciplinary interventions.

Medication overuse headache (MOH); Non-pharmacological interventions; Multidisciplinary approach; Patient education; Withdrawal

[1] Ashina S, Terwindt GM, Steiner TJ, Lee MJ, Porreca F, Tassorelli C, et al. Medication overuse headache. Nature Reviews Disease Primers. 2023; 9: 5.

[2] Tassorelli C, Diener H-C, Dodick DW, Silberstein SD, Lipton RB, Ashina M, et al. Guidelines of the International Headache Society for controlled trials of preventive treatment of chronic migraine in adults. Cephalalgia. 2018; 38: 815–832.

[3] Kebede YT, Mohammed BD, Tamene BA, Abebe AT, Dhugasa RW. Medication overuse headache: a review of current evidence and management strategies. Frontiers in Pain Research. 2023; 4: 1194134.

[4] Gosalia H, Moreno-Ajona D, Goadsby PJ. Medication-overuse headache: a narrative review. The Journal of Headache and Pain. 2024; 25: 89.

[5] Probyn K, Bowers H, Caldwell F, Mistry D, Underwood M, Matharu M, et al. Prognostic factors for chronic headache. Neurology. 2017; 89: 291–301.

[6] Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, et al. Medication-overuse headache: a widely recognized entity amidst ongoing debate. The Journal of Headache and Pain. 2018; 19: 50.

[7] Robbins MS, Grosberg BM, Napchan U, Crystal SC, Lipton RB. Clinical and prognostic subforms of new daily-persistent headache. Neurology. 2010; 74: 1358–1364.

[8] Constantinidis TS, Arvaniti C, Fakas N, Rudolf J, Kouremenos E, Giannouli E, et al. The prevalence and burden of medication overuse headache in Greece. Cephalalgia. 2023; 43: 3331024231184909.

[9] Hird MA, Sandoe CH. Medication overuse headache: an updated review and clinical recommendations on management. Current Neurology and Neuroscience Reports. 2023; 23: 389–398.

[10] Hagen K, Linde M, Steiner TJ, Stovner LJ, Zwart JA. Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trøndelag health studies. Pain. 2012; 153: 56–61.

[11] Ukhanova M, Voss RW, Marino M, Huguet N, Bailey SR, Hartung DM, et al. Chronic overlapping pain conditions and long-term opioid treatment. American Journal of Managed Care. 2023; 29: 233–239.

[12] Rhyne C, Cohen JM, Seminerio MJ, Carr K, Krasenbaum LJ. Burden of migraine with acute medication overuse or psychiatric comorbidities and treatment with CGRP pathway-targeted monoclonal antibodies: a review. Medicine. 2023; 102: e33874.

[13] Mastria G, Viganò A, Corrado A, Mancini V, Pirillo C, Badini S, et al. Chronic migraine preventive treatment by prefrontal-occipital transcranial direct current stimulation (tDCS): a proof-of-concept study on the effect of psychiatric comorbidities. Frontiers in Neurology. 2021; 12: 654900.

[14] Bottiroli S, Renzi A, Ballante E, De Icco R, Sances G, Tanzilli A, et al. Personality in chronic headache: a systematic review with meta-analysis. Pain Research and Management. 2023; 2023: 6685372.

[15] Bottiroli S, Galli F, Viana M, Sances G, Tassorelli C. Traumatic experiences, stressful events, and alexithymia in chronic migraine with medication overuse. Frontiers in Psychology. 2018; 9: 704.

[16] Fumal A, Laureys S, Di Clemente L, Boly M, Bohotin V, Vandenheede M, et al. Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. Brain. 2006; 129: 543–550.

[17] Viganò A, Petolicchio B, Toscano M, Giuliani G, Diani N, Altieri M, et al. A Cox’s hazard model for new development of medication overuse headache in pure chronic migraine patients under migraine prophylaxis. Acta Neurologica Belgica. 2025; 125: 793–800.

[18] Diener HC, Dichgans J, Scholz E, Geiselhart S, Gerber WD, Bille A. Analgesic-induced chronic headache: long-term results of withdrawal therapy. Journal of Neurology. 1989; 236: 9–14.

[19] Grazzi L, Andrasik F, Usai S, Bussone G. Headache with medication overuse: treatment strategies and proposals of relapse prevention. Neurological Sciences. 2008; 29: 93–98.

[20] Silvestro M, Orologio I, Sozio P, Dortucci V, Trojsi F, Siciliano M, et al. No additional benefit with detoxification strategies: a real world experience in 200 patients with chronic migraine and either simple or complex MOH treated with CGRP monoclonal antibodies. Cephalalgia. 2025; 45: 3331024251329808.

[21] Schwedt TJ, Hentz JG, Sahai-Srivastava S, Murinova N, Spare NM, Treppendahl C, et al. Patient-centered treatment of chronic migraine with medication overuse: a prospective, randomized, pragmatic clinical trial. Neurology. 2022; 98: e1409–e1421.

[22] Sebastianelli G, Casillo F, Abagnale C, Renzo AD, Cioffi E, Parisi V, et al. Central sensitization mechanisms in chronic migraine with medication overuse headache: a study of thalamocortical activation and lateral cortical inhibition. Cephalalgia. 2023; 43: 3331024231202240.

[23] Guzman G, Kopruszinski CM, Barber KR, Lillo Vizin RC, Dodick DW, Navratilova E, et al. Chronification of migraine sensitizes to CGRP in male and female mice. Cephalalgia. 2025; 45: 3331024251317446.

[24] Ma Z, Li C, Bai W, Xie W, Zhang M, Xiao H, et al. Induction of more severe central sensitization in a medication overuse headache model mice through active ingestion of rizatriptan. The Journal of Headache and Pain. 2025; 26: 123.

[25] Bogdanov VB, Bogdanova OV, Viganò A, Noirhomme Q, Laureys S, Dallel R, et al. Increased cerebral responses to salient transitions between alternating stimuli in chronic migraine with medication overuse headache and during migraine attacks. Cephalalgia. 2019; 39: 988–999.

[26] Jao CW, Wu YT, Chen WH, Yeh JH, Tsai YF, Hsiao CY, et al. Brain structural network modular and connectivity alterations in subtypes of patients with migraine and medication overuse headache. Progress in Brain Research. 2024; 290: 23–61.

[27] Grazzi L, Chiapparini L, Ferraro S, Usai S, Andrasik F, Mandelli ML, et al. Chronic migraine with medication overuse pre-post withdrawal of symptomatic medication: clinical results and FMRI correlations. Headache. 2010; 50: 998–1004.

[28] Gaul C, Liesering-Latta E, Schäfer B, Fritsche G, Holle D. Integrated multidisciplinary care of headache disorders: a narrative review. Cephalalgia. 2016; 36: 1181–1191.

[29] Gaul C, van Doorn C, Webering N, Dlugaj M, Katsarava Z, Diener HC, et al. Clinical outcome of a headache-specific multidisciplinary treatment program and adherence to treatment recommendations in a tertiary headache center: an observational study. The Journal of Headache and Pain. 2011; 12: 475–483.

[30] de Goffau MJ, Klaver ARE, Willemsen MG, Bindels PJE, Verhagen AP. The effectiveness of treatments for patients with medication overuse headache: a systematic review and meta-analysis. The Journal of Pain. 2017; 18: 615–627.

[31] Krymchantowski A, Jevoux C, Krymchantowski AG, Ramos LB, Barbosa JSS, Silva-Neto RP. Medication-overuse headache—a review of different treatment strategies. Frontiers in Pain Research. 2023; 4: 1103497.

[32] Zebenholzer K, Thamer M, Wöber C. Quality of life, depression, and anxiety 6 months after inpatient withdrawal in patients with medication overuse headache: an observational study. The Clinical Journal of Pain. 2012; 28: 284–290.

[33] Cuciureanu DI, Bistriceanu CE, Vulpoi GA, Cuciureanu T, Antochi F, Roceanu AM. Migraine comorbidities. Life. 2024; 14: 74.

[34] Munksgaard SB, Bendtsen L, Jensen RH. Detoxification of medication-overuse headache by a multidisciplinary treatment programme is highly effective: a comparison of two consecutive treatment methods in an open-label design. Cephalalgia. 2012; 32: 834–844.

[35] Wallasch TM, Angeli A, Kropp P. Outcomes of a headache-specific cross-sectional multidisciplinary treatment program. Headache. 2012; 52: 1094–1105.

[36] Wallasch TM, Hermann C. Validation of criterion-based patient assignment and treatment effectiveness of a multidisciplinary modularized managed care program for headache. The Journal of Headache and Pain. 2012; 13: 379–387.

[37] Zeeberg P, Olesen J, Jensen R. Efficacy of multidisciplinary treatment in a tertiary referral headache centre. Cephalalgia. 2005; 25: 1159–1167.

[38] Jensen R, Zeeberg P, Dehlendorff C, Olesen J. Predictors of outcome of the treatment programme in a multidisciplinary headache centre. Cephalalgia. 2010; 30: 1214–1224.

[39] Lemstra M, Stewart B, Olszynski WP. Effectiveness of multidisciplinary intervention in the treatment of migraine: a randomized clinical trial. Headache. 2002; 42: 845–854.

[40] Harpole LH, Samsa GP, Jurgelski AE, Shipley JL, Bernstein A, Matchar DB. Headache management program improves outcome for chronic headache. Headache. 2003; 43: 715–724.

[41] Gunreben-Stempfle B, Griessinger N, Lang E, Muehlhans B, Sittl R, Ulrich K. Effectiveness of an intensive multidisciplinary headache treatment program. Headache. 2009; 49: 990–1000.

[42] Maizels M, Saenz V, Wirjo J. Impact of a group-based model of disease management for headache. Headache. 2003; 43: 621–627.

[43] Rothrock JF, Parada VA, Sims C, Key K, Walters NS, Zweifler RM. The impact of intensive patient education on clinical outcome in a clinic-based migraine population. Headache. 2006; 46: 726–731.

[44] Gaul C, Visscher CM, Bhola R, Sorbi MJ, Galli F, Rasmussen AV, et al. Team players against headache: multidisciplinary treatment of primary headaches and medication overuse headache. The Journal of Headache and Pain. 2011; 12: 511–519.

[45] Magnusson JE, Riess CM, Becker WJ. Effectiveness of a multidisciplinary treatment program for chronic daily headache. Canadian Journal of Neurological Sciences. 2004; 31: 72–79.

[46] Matchar DB, Harpole L, Samsa GP, Jurgelski A, Lipton RB, Silberstein SD, et al. The headache management trial: a randomized study of coordinated care. Headache. 2008; 48: 1294–1310.

[47] Lake AE III, Saper JR, Hamel RL. Comprehensive inpatient treatment of refractory chronic daily headache. Headache. 2009; 49: 555–562.

[48] D’Amico D, Grazzi L, Tepper SJ. Management of medication overuse headache. Handbook of Clinical Neurology. 2024; 199: 277–299.

[49] Diener HC, Kropp P, Dresler T, Evers S, Förderreuther S, Gaul C, et al. Management of medication overuse (MO) and medication overuse headache (MOH) S1 guideline. Neurological Research and Practice. 2022; 4: 37.

[50] Koonalintip P, Yamutai S, Setthawatcharawanich S, Thongseiratch T, Chichareon P, Wakerley BR. Network meta-analysis comparing efficacy of different strategies on medication-overuse headache. The Journal of Headache and Pain. 2025; 26: 43.

[51] Rossi P, Faroni JV, Tassorelli C, Nappi G. Advice alone versus structured detoxification programmes for complicated medication overuse headache (MOH): a prospective, randomized, open-label trial. The Journal of Headache and Pain. 2013; 14: 10.

[52] Rossi P, Jensen R, Nappi G, Allena M. A narrative review on the management of medication overuse headache: the steep road from experience to evidence. The Journal of Headache and Pain. 2009; 10: 407–417.

[53] Kristoffersen ES, Straand J, Vetvik KG, Benth JŠ, Russell MB, Lundqvist C. Brief intervention by general practitioners for medication-overuse headache, follow-up after 6 months: a pragmatic cluster-randomised controlled trial. Journal of Neurology. 2016; 263: 344–353.

[54] Rossi P, Di Lorenzo C, Faroni J, Cesarino F, Nappi G. Advice alone vs. structured detoxification programmes for medication overuse headache: a prospective, randomized, open-label trial in transformed migraine patients with low medical needs. Cephalalgia. 2006; 26: 1097–1105.

[55] Chiang CC, Schwedt TJ, Wang SJ, Dodick DW. Treatment of medication-overuse headache: a systematic review. Cephalalgia. 2016; 36: 371–386.

[56] Mauskop A, Katsarava Z, Fritsche G, Muessig M, Diener HC, Limmroth V. Clinical features of withdrawal headache following overuse of triptans and other headache drugs. Neurology. 2002; 58: 1443–1444.

[57] Grazzi L, Andrasik F, Usai S, Bussone G. In-patient vs. day-hospital withdrawal treatment for chronic migraine with medication overuse and disability assessment: results at one-year follow-up. Neurological Sciences. 2008; 29: S161–S163.

[58] Weatherall MW, Telzerow AJ, Cittadini E, Kaube H, Goadsby PJ. Intravenous aspirin (lysine acetylsalicylate) in the inpatient management of headache. Neurology. 2010; 75: 1098–1103.

[59] Lee MJ, Park HK, Oh SY, Kang JJ, Hong Y, Moon HS, et al. Effect of prednisolone for the treatment of medication-overuse headache: a 3-month result from a multicenter REgistry for load and management of mEdicAtion overuSE headache (RELEASE) study. Headache. 2024; 64: 149–155.

[60] Rabe K, Pageler L, Gaul C, Lampl C, Kraya T, Foerderreuther S, et al. Prednisone for the treatment of withdrawal headache in patients with medication overuse headache: a randomized, double-blind, placebo-controlled study. Cephalalgia. 2013; 33: 202–207.

[61] Kaltseis K, Hamann T, Gaul C, Broessner G. Is prednisone still a reasonable option in the treatment of withdrawal headache in patients with chronic migraine and medication overuse headache in the age of CGRP antibodies? A narrative review. Headache. 2022; 62: 1264–1271.

[62] Kong F, Buse DC, Zhu G, Xu J. Comparative efficacy and safety of different pharmacological therapies to medication overuse headache: a network meta-analysis. The Journal of Headache and Pain. 2024; 25: 168.

[63] Giri S, Tronvik E, Linde M, Pedersen SA, Hagen K. Randomized controlled studies evaluating topiramate, botulinum toxin type A, and mABs targeting CGRP in patients with chronic migraine and medication overuse headache: a systematic review and meta-analysis. Cephalalgia. 2023; 43: 3331024231156922.

[64] Oliveira R, Gil-Gouveia R, Puledda F. CGRP-targeted medication in chronic migraine—systematic review. The Journal of Headache and Pain. 2024; 25: 51.

[65] Rocha-Filho PAS. Calcitonin gene-related peptide monoclonal antibodies and medication-overuse headache: stopping excessive pain medication is still necessary. Arquivos de Neuro-Psiquiatria. 2025; 83: 1–4.

[66] Nguyen N, Ho Quang Tri V, Nguyen Ngoc Dan V, Bao Tran N, Olah L, Heja M. Safety, efficacy, and compliance of moderate-to-high dose eptinezumab and erenumab in chronic migraine patients with medication-overuse headache: an updated systematic review and meta-analysis. The Journal of Headache and Pain. 2025; 26: 99.

[67] McCracken HT, Thaxter LY, Smitherman TA. Psychiatric comorbidities of migraine. Handbook of Clinical Neurology. 2024; 199: 505–516.

[68] Diener HC, Antonaci F, Braschinsky M, Evers S, Jensen R, Lainez M, et al. European Academy of Neurology guideline on the management of medication-overuse headache. European Journal of Neurology. 2020; 27: 1102–1116.

[69] Gillieron E. Short psychotherapeutic interventions (four sessions). Psychotherapy and Psychosomatics. 1989; 51: 32–37.

[70] Viganò A, Petolicchio B, Toscano M, Ruggero S, Di Giambattista R, Puma M, et al. Real-world application of short term psychodynamic psychotherapy (STPP) as chronic migraine preventive therapy: profiling responders and predictive factors. Neurological Sciences. 2025; 46: 2727–2736.

[71] Aemaz Ur Rehman M, Waseem R, Habiba U, Fahad Wasim M, Alam Rehmani S, Alam Rehmani M, et al. Efficacy of mindfulness-based intervention for the treatment of chronic headaches: a systematic review and meta-analysis. Annals of Medicine and Surgery. 2022; 78: 103862.

[72] Grazzi L, D’Amico D, Guastafierro E, Demichelis G, Erbetta A, Fedeli D, et al. Efficacy of mindfulness added to treatment as usual in patients with chronic migraine and medication overuse headache: a phase-III single-blind randomized-controlled trial (the MIND-CM study). The Journal of Headache and Pain. 2023; 24: 86.

[73] Treadwell JR, Tsou AY, Rouse B, Ivlev I, Fricke J, Buse DC, et al. Behavioral interventions for migraine prevention: a systematic review and meta-analysis. Headache. 2025; 65: 668–694.

[74] Amatrudo G, Kengetter J, McCrea S, Amatrudo M. Cognitive behavioral therapy for the management of episodic migraine. Current Pain and Headache Reports. 2023; 27: 471–477.

[75] Pijpers JA, Kies DA, van Zwet EW, Rosendaal FR, Terwindt GM. Behavioural intervention in medication overuse headache: a concealed double-blind randomized controlled trial. European Journal of Neurology. 2022; 29: 1496–1504.

[76] Wright SL, Karyotaki E, Cuijpers P, Bisson J, Papola D, Witteveen A, et al. EMDR v. other psychological therapies for PTSD: a systematic review and individual participant data meta-analysis. Psychological Medicine. 2024; 54: 1580–1588.

[77] Tesarz J, Leisner S, Gerhardt A, Janke S, Seidler GH, Eich W, et al. Effects of eye movement desensitization and reprocessing (EMDR) treatment in chronic pain patients: a systematic review. Pain Medicine. 2014; 15: 247–263.

[78] Ryan CG, Gray HG, Newton M, Granat MH. Pain biology education and exercise classes compared to pain biology education alone for individuals with chronic low back pain: a pilot randomised controlled trial. Manual Therapy. 2010; 15: 382–387.

[79] van den Hoek TC, Pijpers JA, van Zwet EW, de Boer I, Terwindt GM. Pain coping in patients with chronic migraine and medication overuse headache. Brain and Behavior. 2025; 15: e70739.

[80] Tolentino GA, Florencio LL, Pradela J, Pinheiro-Araújo CF, Martins J, de Cassia Cabral Norato A, et al. Effects of combining manual therapies, neck muscle exercises, and therapeutic education pain neuroscience in patients with migraine: a 3-armed randomized clinical trial. Musculoskeletal Science & Practice. 2025; 78: 103360.

[81] Mose LS, Jensen RH, Nygaard NPB, Pedersen SS, Gram B. Use of coping strategies in the management of medication overuse headache. Patient Education and Counseling. 2022; 105: 390–397.

[82] Tomás-Rodríguez MI, Asensio-García MDR, García RN, Delicado-Miralles M, Sánchez SH, Segura-Heras JV. Short- and medium-term effects of a single session of pain neuroscience education on pain and psychological factors in patients with chronic low back pain. A single-blind randomized clinical trial. European Journal of Pain. 2024; 28: 1841–1854.

[83] Lepri B, Romani D, Storari L, Barbari V. Effectiveness of pain neuroscience education in patients with chronic musculoskeletal pain and central sensitization: a systematic review. International Journal of Environmental Research and Public Health. 2023; 20: 4098.

[84] Balordi M, Tiberio P, Castaldo M, Viganò A, Jacobs F, Zambelli A, et al. Empowering beyond pain: pain neuroscience education interventions in breast cancer survivorship care. Cancers. 2024; 16: 2806.

[85] Tiberio P, Balordi M, Castaldo M, Viganò A, Jacobs F, Benvenuti C, et al. Empowerment, pain control, and quality of life improvement in early triple-negative breast cancer patients through pain neuroscience education: a prospective cohort pilot study protocol (EMPOWER trial). Journal of Personalized Medicine. 2024; 14: 711.

[86] Sidiq M, Muzaffar T, Janakiraman B, Masoodi S, Vasanthi RK, Ramachandran A, et al. Effects of pain education on disability, pain, quality of life, and self-efficacy in chronic low back pain: a randomized controlled trial. PLOS ONE. 2024; 19: e0294302.

[87] Dominguez M, Minen M, Robbins MS. Educational initiatives in headache medicine: a 20-year scoping review. Headache. 2023; 63: 861–871.

[88] Mingels S, Granitzer M, Luedtke K, Dankaerts W. Therapeutic patient education as part of the physiotherapy management of adults with headache: a scoping review. Current Pain and Headache Reports. 2024; 28: 547–564.

[89] Suso-Martí L, Cuenca-Martínez F, Alba-Quesada P, Muñoz-Alarcos V, Herranz-Gómez A, Varangot-Reille C, et al. Effectiveness of pain neuroscience education in patients with fibromyalgia: a systematic review and meta-analysis. Pain Medicine. 2022; 23: 1837–1850.

[90] Kindelan-Calvo P, Gil-Martínez A, Paris-Alemany A, Pardo-Montero J, Muñoz-García D, Angulo-Díaz-Parreño S, et al. Effectiveness of therapeutic patient education for adults with migraine. A systematic review and meta-analysis of randomized controlled trials. Pain Medicine. 2014; 15: 1619–1636.

[91] Minen MT, Kaplan K, Akter S, Espinosa-Polanco M, Guiracocha J, Khanns D, et al. Neuroscience education as therapy for migraine and overlapping pain conditions: a scoping review. Pain Medicine. 2021; 22: 2366–2383.

[92] Castaldo M, Atzori T, Comanducci A, Querzola G, Derchi CC, Lovattini D, et al. A randomized, double-blind, controlled trial protocol for therapeutic neuroscience education in chronic migraine patients: a clinical-neurophysiological combined study design. Methods and Protocols. 2025; 8: 22.

[93] Shagbazyan A, Kovalchuk N, Tabeeva G. Role of educational programs in management of patients with medication-overuse headache. Neurology, Neuropsychiatry, Psychosomatics. 2021; 13: 27–33.

[94] Meise R, Carvalho GF, Thiel C, Luedtke K. Additional effects of pain neuroscience education combined with physiotherapy on the headache frequency of adult patients with migraine: a randomized controlled trial. Cephalalgia. 2023; 43: 3331024221144781.

[95] Onan D, Ekizoğlu E, Arıkan H, Taşdelen B, Özge A, Martelletti P. The efficacy of physical therapy and rehabilitation approaches in chronic migraine: a systematic review and meta-analysis. Journal of Integrative Neuroscience. 2023; 22: 126.

[96] Trager RJ, Williamson TJ, Makineni PS, Morris LH. Association between spinal manipulation, butalbital prescription, and medication overuse headache in adults with tension-type headache: retrospective cohort study. Health Science Reports. 2024; 7: e70218.

[97] Onan D, Arıkan H, Martelletti P. The effect of onabotulinumtoxinA on headache intensity and number of monthly headache days in individuals with chronic migraine with different levels of neck disability. Toxins. 2023; 15: 685.

[98] Luedtke K, Carvalho G, Szikszay T. Musculoskeletal dysfunctions and physiotherapy treatment strategies in patients with migraine. Musculoskeletal Science & Practice. 2023; 66: 102805.

[99] Jung A, Eschke RC, Struss J, Taucher W, Luedtke K. Effectiveness of physiotherapy interventions on headache intensity, frequency, duration and quality of life of patients with tension-type headache. A systematic review and network meta-analysis. Cephalalgia. 2022; 42: 944–965.

[100] Chaibi A, Russell MB. Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. The Journal of Headache and Pain. 2014; 15: 1–8.

[101] Muñoz-Gómez E, Serra-Añó P, Mollà-Casanova S, Sempere-Rubio N, Aguilar-Rodríguez M, Espí-López GV, et al. Potential add-on effects of manual therapy techniques in migraine patients: a randomised controlled trial. Journal of Clinical Medicine. 2022; 11: 4686.

[102] Varangot-Reille C, Suso-Martí L, Dubuis V, Cuenca-Martínez F, Blanco-Díaz M, Salar-Andreu C, et al. Exercise and manual therapy for the treatment of primary headache: an umbrella and mapping review. Physical Therapy. 2022; 102: 1–11.

[103] Amin FM, Aristeidou S, Baraldi C, Czapinska-Ciepiela EK, Ariadni DD, Di Lenola D, et al. The association between migraine and physical exercise. The Journal of Headache and Pain. 2018; 19: 83.

[104] American Headache Society. The American Headache Society position statement on integrating new migraine treatments into clinical practice. Headache. 2019; 59: 1–18.

[105] Schytz HW, Amin FM, Jensen RH, Carlsen L, Maarbjerg S, Lund N, et al. Reference programme: diagnosis and treatment of headache disorders and facial pain. Danish Headache Society, 3rd edition, 2020. The Journal of Headache and Pain. 2021; 22: 22.

[106] Demarquay G, Mawet J, Guégan-Massardier E, de Gaalon S, Donnet A, Giraud P, et al. Revised guidelines of the French headache society for the diagnosis and management of migraine in adults. Part 3: non-pharmacological treatment. Revista de Neurología. 2021; 177: 753–759.

[107] La Touche R, Fierro-Marrero J, Sánchez-Ruíz I, Rodríguez de Rivera-Romero B, Cabrera-López CD, Lerma-Lara S, et al. Prescription of therapeutic exercise in migraine, an evidence-based clinical practice guideline. The Journal of Headache and Pain. 2023; 24: 68.

[108] Martín-Vera D, Sánchez-Sierra A, González-de-la-Flor Á, García-Pérez-de-Sevilla G, Domínguez-Balmaseda D, del-Blanco-Muñiz JÁ. Efficacy of a strength-based exercise program in patients with chronic tension type headache: a randomized controlled trial. Frontiers in Neurology. 2023; 14: 1256303.

[109] Varangot-Reille C, Suso-Martí L, Romero-Palau M, Suárez-Pastor P, Cuenca-Martínez F. Effects of different therapeutic exercise modalities on migraine or tension-type headache: a systematic review and meta-analysis with a replicability analysis. The Journal of Pain. 2022; 23: 1099–1122.

[110] Woldeamanuel YW, Oliveira ABD. What is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta-analysis of clinical trials. The Journal of Headache and Pain. 2022; 23: 134.

[111] Reina-Varona Á, Madroñero-Miguel B, Gaul C, Hall T, Oliveira AB, Bond DS, et al. Therapeutic exercise parameters, considerations, and recommendations for migraine treatment: an international Delphi study. Physical Therapy. 2023; 103: pzad080.

[112] Vázquez-Justes D, Yarzábal-Rodríguez R, Doménech-García V, Herrero P, Bellosta-López P. Effectiveness of dry needling for headache: a systematic review. Neurologia. 2022; 37: 806–815.

[113] Monti-Ballano S, Márquez-Gonzalvo S, Lucha-López MO, Ferrández-Laliena L, Vicente-Pina L, Sánchez-Rodríguez R, et al. Effects of dry needling on active myofascial trigger points and pain intensity in tension-type headache: a randomized controlled study. Journal of Personalized Medicine. 2024; 14: 332.

[114] Viganò A, Toscano M, Puledda F, Di Piero V. Treating chronic migraine with neuromodulation: the role of neurophysiological abnormalities and maladaptive plasticity. Frontiers in Pharmacology. 2019; 10: 32.

[115] Schoenen J, Vandersmissen B, Jeangette S, Herroelen L, Vandenheede M, Gérard P, et al. Migraine prevention with a supraorbital transcutaneous stimulator: a randomized controlled trial. Neurology. 2013; 80: 697–704.

[116] Lipton RB, Dodick DW, Silberstein SD, Saper JR, Aurora SK, Pearlman SH, et al. Single-pulse transcranial magnetic stimulation for acute treatment of migraine with aura: a randomised, double-blind, parallel-group, sham-controlled trial. The Lancet Neurology. 2010; 9: 373–380.

[117] Di Fiore P, Bussone G, Galli A, Didier H, Peccarisi C, D’Amico D, et al. Transcutaneous supraorbital neurostimulation for the prevention of chronic migraine: a prospective, open-label preliminary trial. Neurological Sciences. 2017; 38: 201–206.

[118] Ornello R, Caponnetto V, Ratti S, D’Aurizio G, Rosignoli C, Pistoia F, et al. Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials. The Journal of Headache and Pain. 2021; 22: 144.

[119] De Icco R, Putortì A, De Paoli I, Ferrara E, Cremascoli R, Terzaghi M, et al. Anodal transcranial direct current stimulation in chronic migraine and medication overuse headache: a pilot double-blind randomized sham-controlled trial. Clinical Neurophysiology. 2021; 132: 126–136.

[120] Grazzi L, Usai S, Bolognini N, Grignani E, Sansone E, Tramacere I, et al. No efficacy of transcranial direct current stimulation on chronic migraine with medication overuse: a double blind, randomised clinical trial. Cephalalgia. 2020; 40: 1202–1211.

[121] Mansour AG, Ahdab R, Khazen G, El-Khoury C, Sabbouh TM, Salem M, et al. Transcranial direct current stimulation of the occipital cortex in medication overuse headache: a pilot randomized controlled cross-over study. Journal of Clinical Medicine. 2020; 9: 1075.

[122] Lefaucheur JP, Antal A, Ayache SS, Benninger DH, Brunelin J, Cogiamanian F, et al. Evidence-based guidelines on the therapeutic use of transcranial direct current stimulation (tDCS). Clinical Neurophysiology. 2017; 128: 56–92.

[123] Lloyd JO, Hill B, Murphy M, Al-Kaisy A, Andreou AP, Lambru G. Single-pulse transcranial magnetic stimulation for the preventive treatment of difficult-to-treat migraine: a 12-month prospective analysis. The Journal of Headache and Pain. 2022; 23: 63.

[124] Hamada M, Terao Y, Hanajima R, Shirota Y, Nakatani-Enomoto S, Furubayashi T, et al. Bidirectional long-term motor cortical plasticity and metaplasticity induced by quadripulse transcranial magnetic stimulation. The Journal of Physiology. 2008; 586: 3927–3947.

[125] Viganò A, Sasso D’Elia T, Sava SL, Colosimo A, Di Piero V, Magis D, et al. Exploring the therapeutic potential of quadripulse rTMS over the visual cortex: a proof-of-concept study in healthy volunteers and chronic migraine patients with medication overuse headache. Biomedicines. 2024; 12: 288.

[126] Gazerani P. Migraine and diet. Nutrients. 2020; 12: 1–11.

[127] Gazerani P. Diet and migraine: what is proven? Current Opinion in Neurology. 2023; 36: 615–621.

[128] Ceren Akgor M, Vuralli D, Sucu DH, Gokce S, Tasdelen B, Gultekin F, et al. Distinct food triggers for migraine, medication overuse headache and irritable bowel syndrome. Journal of Clinical Medicine. 2023; 12: 6488.

[129] Liu H, Zhao H, Liu K, Jia Z, Dong M, Cheng Y, et al. Association between body mass index and medication-overuse headache among individuals with migraine: a cross-sectional study. Obesity Facts. 2024; 17: 286–295.

[130] Bond DS, Roth J, Nash JM, Wing RR. Migraine and obesity: epidemiology, possible mechanisms and the potential role of weight loss treatment. Obesity Reviews. 2011; 12: e362–e371.

[131] Di Lorenzo C, Ballerini G, Barbanti P, Bernardini A, D’Arrigo G, Egeo G, et al. Applications of ketogenic diets in patients with headache: clinical recommendations. Nutrients. 2021; 13: 2307.

[132] Niezen S, Connelly MA, Hirsch C, Kizer JR, Benitez ME, Minchenberg S, et al. Elevated plasma levels of ketone bodies are associated with all-cause mortality and incidence of heart failure in older adults: the CHS. Journal of the American Heart Association. 2023; 12: e029960.

[133] Gao X, Wang Y, Meng H, Li S, Jiang H, Zhang Z, et al. Acupuncture for brain diseases: conception, application, and exploration. The Anatomical Record. 2023; 306: 2958–2973.

[134] Liu L, Chen Q, Zhao L, Lyu T, Nie L, Miao Q, et al. Acupuncture plus topiramate placebo versus topiramate plus sham acupuncture for the preventive treatment of chronic migraine: a single-blind, double-dummy, randomized controlled trial. Cephalalgia. 2024; 44: 3331024241261080.

[135] Zheng H, Huang SL, Chen YY, Tang TC, Qin D, Chen M. Topiramate, acupuncture, and BoNT-A for chronic migraine: a network meta-analysis. Acta Neurologica Scandinavica. 2021; 143: 558–568.

[136] Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Annals of Internal Medicine. 2002; 136: 374–383.

[137] Soman A, Venkatram S, Chikkanna U, Ramakrishna K, Bhargav H, Mailankody P, et al. Ayurveda for management of migraine: a narrative review of clinical evidence. Journal of Family Medicine and Primary Care. 2022; 11: 4228–4235.

[138] Witt CM, Michalsen A, Roll S, Morandi A, Gupta S, Rosenberg M, et al. Comparative effectiveness of a complex Ayurvedic treatment and conventional standard care in osteoarthritis of the knee—study protocol for a randomized controlled trial. Trials. 2013; 14: 149.

[139] Czigle S, Nagy M, Mladěnka P, Tóth J; OEMONOM. Pharmacokinetic and pharmacodynamic herb-drug interactions-part I. Herbal medicines of the central nervous system. PeerJ. 2023; 11: e16149.

[140] Diener HC, Holle D, Solbach K, Gaul C. Medication-overuse headache: risk factors, pathophysiology and management. Nature Reviews Neurology. 2016; 12: 575–583.

[141] Mingels S, Granitzer M, Luedtke K, Dankaerts W. What is the status quo of patient-centred physiotherapy management of people with headache within a biopsychosocial model?—A narrative review. Current Pain and Headache Reports. 2024; 28: 1195–1207.

[142] Rosignoli C, Ornello R, Onofri A, Caponnetto V, Grazzi L, Raggi A, et al. Applying a biopsychosocial model to migraine: rationale and clinical implications. The Journal of Headache and Pain. 2022; 23: 100.