Effect of Educational and Behavioral Interventions on Medication-Overuse Headache: A Systematic Review and Meta-Analysis

Background: Medication-overuse headache (MOH) is a disabling secondary headache arising from frequent acute medication intake in individuals with preexisting primary headache. Behavioral and psychosocial factors may perpetuate medication overuse. As a reduction of acute medication intake is essential for remission, educational and behavioral interventions are commonly used; however, their effectiveness remains uncertain. Objectives: To systematically evaluate the effectiveness of educational and behavioral interventions on acute medication use, headache frequency, and headache-related disability in patients with MOH, and to assess short- and longer-term outcomes compared to usual care. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from inception to January 2026 for randomized controlled trials evaluating educational or behavioral interventions in adults with MOH. Outcomes included reduction of acute medication use, headache frequency, and headache-related disability. Random-effects meta-analyses were performed where appropriate. Results: Six trials (610 participants) were included. Brief educational interventions were associated with clinically meaningful reductions in acute medication use and headache frequency. Multiple-session interventions, compared to minimal intervention, were associated with additional mean reductions in acute medication use of approximately 3 days per month and in headache frequency of 2.6 days per month at 3 months and 0.8 days per month at 12 months; however, between-group differences were not statistically significant. Substantial heterogeneity was observed. Conclusions: Brief educational interventions may be considered as a potentially useful component of MOH care. Multisession interventions may offer additional benefit but remain inconclusive because of heterogeneity and limited evidence. Further high-quality trials are needed to define optimal strategies.