There is no accepted standard of care for the treatment of medication overuse headaches, and there is insufficient data from appropriately powered randomized clinical trials (RCTs) for us to suggest a particular course of action (de Goffau et al. 2017). The generalizability of these results is doubtful due to the selection of patients with high motivation, exclusion of patients with prior detoxification failures and comorbid psychiatric illnesses, high dropout rates, and uncontrolled trials without intention-to-treat analyses. Tertiary care centers frequently report high rates of treatment success. Individuals with medication overuse headaches range from those who have migraine without comorbidities and are abusing just one medicine to those who have a variety of headaches, significant comorbidity, behavioral dependence, and excessive drug use.
Studies also demonstrate that these disparities are partially culturally conditioned and that medications are misused when they are readily available and reasonably priced (Find et al. 2015).

The general recommendation of management is (de Goffau et al. 2017):

1. Make a correct diagnosis based on criteria and the exclusion of other headaches
2. Patient Education
3. Abrupt withdrawal of overused medication with or without rescue medicine
4. Evaluation of who should receive prophylaxis prior to, at onset of, or after drug withdrawal
5. Follow-up to avoid relapses & advice about follow-up treatments

Both the prevention and treatment of medication overuse headache are possible, but they are not always simple tasks. The majority of patients should likely be given the option of outpatient withdrawal, although complex situations may necessitate inpatient care. The results of a recent trial with a consensus protocol (Tassorelli et al. 2014)—which included advice on medication withdrawal, early discontinuation with supportive treatment for withdrawal headache,  optional early preventive medication, symptomatic treatment using a different medication than the one previously overused, and follow-up over a 6-month period—support the existing recommendations that the majority of patients will benefit from a stepwise combination of advice, withdrawal of overused medications, and monitoring over time.