Clinical characteristics of medication‐overuse headache according to the class of acute medication: A cross‐sectional multicenter study

Abstract

Objective: To characterize the clinical features of patients with medication-overuse headache (MOH) according to the class of acute medications being overused. Background: MOH is a common global health problem, severely disabling the majority of the patients affected. Although various medications can cause MOH, whether clinical features differ according to the overused medication type remains unclear. Methods: We analyzed data from a multicenter cross-sectional study in neurology clinics in Korea from April 2020 to June 2021. Results: Among 229 eligible patients, MOH was documented in patients who overused multiple drug classes (69/229, 30.1%; most frequent occurrence), triptans (50/229, 21.8%), non-opioid analgesics (48/229, 21.0%), and combination-analgesics (40/229, 17.4%). Patients who overused multiple drug classes reported more frequent use of acute medications (median [25th-75th

Medication-Overuse Headache

“…The most frequently overused individual medications implicated in the development of MOH appear to be triptans, opioids, and barbiturates. However, a 2022 study of a patient population not exposed to barbiturates suggested that, overall, the most common profile was a patient overusing multiple individual abortive medications, such as triptans along with nonopioid analgesics 20 . This finding supports the ICHD’s 2005 addition of the category 8.2.6 Medication-overuse headache attributed to multiple drug classes not individually overused as a subform of MOH.…”

Activation of the microglial P2X7R/NLRP3 inflammasome mediates central sensitization in a mouse model of medication overuse headache

“…In the ICHD-3, the diagnosis of MOH is subdivided according to the drugs used, including simple analgesics such as acetaminophen or NSAIDs for at least 15 days each month and triptans, ergot derivatives or mixed analgesics for at least 10 days each month. Although there are several medications that can cause MOH, triptans are more commonly used to treat migraine patients in clinical practice ( Oh et al, 2022 ). Patients who overuse triptans develop MOH more quickly than those who use other drugs, such as ergotamines, and have headaches that are more similar to migraine ( Limmroth et al, 2002 ).…”

The state of the art in treating patients with a dual diagnosis of chronic migraine and medication-overuse headache

“…4,5 Medication-Overuse Headache (MOH) is also highly prevalent and secondary to the overuse of analgesics, anti-inflammatory drugs, or specific migraine medications (triptans or ergots) on ≥10 days per month, which precipitates and/or perpetuates a headache on ≥15 days per month, for ≥3 months in sufferers with a primary head pain such as migraine or tension-type headache. [1][2][3][4][5][6] The traditional clinical view, reflected in the International Classification of Headache Disorders, is that most people with chronic primary headaches have the so-called medication overuse headache and chronic migraineurs without MOH are not easily encountered in clinical practice of Brazil. 1,6,7 Therefore, the condition is secondary, and described in group 8 of the ICHD-3.…”

“…[1][2][3][4][5][6] The traditional clinical view, reflected in the International Classification of Headache Disorders, is that most people with chronic primary headaches have the so-called medication overuse headache and chronic migraineurs without MOH are not easily encountered in clinical practice of Brazil. 1,6,7 Therefore, the condition is secondary, and described in group 8 of the ICHD-3. 1 In tertiary centers, MOH represents the largest group of patients reaching 70 to 80%.…”

“…1 In tertiary centers, MOH represents the largest group of patients reaching 70 to 80%. 6,7 Most sufferers are women (85%), with migraine as the primary headache (99%). The societal costs of treating MOH are three times higher than those of treating episodic migraine.…”