Curr Treat Options Neurol (2017) 19:32 DOI 10.1007/s11940-017-0465-2 Headache (JR Couch, Section Editor) A Critical Evaluation on MOH Current Treatments Andrea Negro, MD 1,2,* Martina Curto, MD, PhD 3 Luana Lionetto, PhD 4 Simona Guerzoni, MD 5 Luigi Alberto Pini, MD, Prof. 5 Paolo Martelletti, MD, Prof. 1,2 Address 1 Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy *,2 Regional Referral Headache Centre, Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00191, Rome, Italy Email: andrea.negro@uniroma1.it 3 Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy 4 Advanced Molecular Diagnostics Unit, IDI Istituto Dermopatico dell’Immacolata - IRCSS, Rome, Italy 5 Department of Diagnostic and Clinical Medicine and Public Health, Proteomic Lab, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy * Springer Science+Business Media, LLC 2017 This article is part of the Topical Collection on Headache Keywords Chronic migraine I Medication overuse headache I Migraine acute drugs overuse I Preventative therapy I Early treatment I OnabotulinumtoxinA Opinion statement Migraine is the most frequent neurological disorder observed in clinical practice characterized by moderate to severe pain attacks associated with neurological, gastrointestinal, and dysautonomic symptoms. Each year, 2.5% of patients with episodic migraine develop chronic migraine (CM). CM is characterized by high frequency of the attacks that may result into chronic intake of abortive medications. Nearly, the 70% of CM patients referring to tertiary head centers show acute pain medications overuse that may lead to the development of medication overuse headache (MOH). The management of MOH requires three steps: (1) education, (2) withdrawal of the overuse drug and detoxification, and (3) re-prophylaxis. In the last years, several real-life prospective studies provided further evidence in clinical setting of the onabotulinumtoxinA 155–195 U efficacy for the headache prophylaxis in CM with MOH patients. There is a general agreement on two factors: (1) withdrawal of the overuse drug is condicio sine qua non to reverse the pattern to medium–low-frequency migraine, and (2) the