Clinical features, pathophysiology, and treatment of medication-overuse headache

Evers, Stefan; Marziniak, Martin

doi:10.1016/s1474-4422(10)70008-9

Cited by 199 publications

(224 citation statements)

References 122 publications

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“…Chronic migraine (CM) with Medication overuse (MO) affects upto 15-30 % of patients with headaches referring to tertiary care clinics [1][2][3]. Some of them present dependency-like behaviors with medications, despite being aware of and concerned about their negative consequences, i.e.…”

Section: Introductionmentioning

confidence: 99%

Psychiatric screening for migraine patients

Gambini

Biagianti

Grazzi³

et al. 2013

Neurol Sci

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Psychiatric disorders in migraine patients have a higher prevalence than general population. The presence of psychiatric comorbidities may influence the complexity of the migraine pictures and be related to medication overuse. Severely impaired chronic migraineurs presenting with medication overuse are a challenge for headache clinics. Psychiatric comorbities, such as dependency-like behaviors, anxiety and mood symptoms, might account for headacherelated disability and recurrent relapses into medication overuse after a successful detoxification. Within a sample of 63 chronic migraineurs with medication overuse and severe disability, we investigated to which extent clinical severity, affective states and attitudes about medication impact the overall functioning at time of detoxification. To unravel whether some of these factors could predict their long-term outcome, we followed and retest them 1 year after withdrawal. We hypothesized that the detoxification would have led to a partial improvement and not modified the attitudes toward medication and dependence. Detoxification improves most of the clinical and affective measures, but does not free from significant levels of pain intensity and headache-related disability. The partial benefit from detoxification, the severity bias and the maladaptive cognitive profile led us to believe that subgroups of chronic-relapsing migraineurs deserve a multidisciplinary approach that addresses not only the reduction of clinical severity but also specific cognitive and behavioral impairments.

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Section: Introductionmentioning

confidence: 99%

Psychiatric screening for migraine patients

Gambini

Biagianti

Grazzi³

et al. 2013

Neurol Sci

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“…Undoubtedly, there are concerns that opioids may be misused or abused, leading to opioids abuse or dependence [12,13]. Analgesic overuse has long been considered a risk factor for transformation of episodic migraine in chronic daily headache (CDH) or medication overuse headache (MOH) [14]. The CDH population includes individuals with chronic tension-type headache and chronic migraine (CM), both of which may be associated with medication overuse [15,16].…”

mentioning

confidence: 99%

Controversies in migraine treatment: opioids should be avoided

Casucci¹,

Cevoli

2013

Neurol Sci

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The use of opioids for migraine is still controversial. Evidence-based guidelines do not recommend opioids as first-line treatment of migraine attacks, while clinical and epidemiological surveys demonstrate that the use of opioids is associated with more severe headacherelated disability, symptomology and comorbidities, and greater health-care resource utilization. There are concerns that opioids may be misused or abused, leading to opioid abuse or dependence and migraineurs are particularly prone and at risk for the development of chronic daily headache from opioids overuse. Since clinical and preclinical studies evidence a pathophysiological role of opioids in migraine progression, opioids should be avoided in migraine patients.The role of opioids in clinical practice for migraine: the state-of-the-art Migraine is a common disabling neurologic disorder, characterized by recurrent headache attacks manifesting with unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity, and association with nausea and/or photophobia and phonophobia [1]. The goals of acute migraine treatments are to treat attacks rapidly and consistently without recurrence, restore the patient's ability to function, minimize the use of back-up and rescue medications, optimize self-care and reduce subsequent use of resources, be cost-effective for overall management, and have minimal or no adverse events [2]. Acute treatments used for migraine include nonspecific agents such as aspirin, acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, and barbiturates among others, as well as migraine-specific medications, including ergot alkaloids and triptans [2]. International guidelines recommend triptans and NSAIDs as first-line treatment of migraine attacks [2][3][4]. Use of opioids for treatment of migraine is controversial. Despite evidence-based guidelines do not recommend opioids as first-line treatment of migraine attacks [2][3][4], and no randomized controlled trial has shown any significant effect of opioids on migraine attacks when pain-free was the primary end-point of the study [5], their use in clinical practice [6][7][8] and, even more, in emergency departments (EDs) is very large, especially in USA and Canada [9,10]. Moreover, among studies about the efficacy of opioids as rescue medication for acute migraine in EDs recently revised, only one evidenced a superiority of meperidina 75 mg i.m. versus ketorolac 30 mg i.m., three reported superiority of competitors and eight reported similar results for opioids versus competitors such as DHE, metoclopramide, chlorpromazine, droperidol, and ketorolac [5]. In any case, opioids did not adequately restore the patient's ability to function. The negative impact of opioids on migrainous population is reported in several clinical and epidemiological studies. In fact, opioids use for migraine resulted associated with more severe headache-related disability, symptomology, and comorbidities (primarily, psychiatric, and cardi...

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“…Cluster headache patients may receive ineffective prophylactic drugs such as propranolol, carbamazepine or amitriptyline (Van Alboom et al 2009). Medication-overuse headache is a major public health concern and affects 0.7% to 1.7% of the population (Evers and Marziniak 2010). Medication-overuse headache has been described in a variety of headache disorders including tension-type headache, migraine and cluster headache (Diener and Limmroth 2004;Paemeleire et al 2006).…”

Section: Rctsmentioning

confidence: 99%

“…Medication-overuse headache has been described in a variety of headache disorders including tension-type headache, migraine and cluster headache (Diener and Limmroth 2004;Paemeleire et al 2006). In principle, all acute drugs for the treatment of headache could cause MOH (Evers and Marziniak 2010).…”

Section: Rctsmentioning

confidence: 99%