Medication-overuse headache: a review

Abstract

Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1%–2%. It is a severe form of headache where the patients often have a long history of headache and of unsuccessful treatments. MOH is characterized by chronic headache and overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This review focuses on aspects of epidemiology, diagnosis, pathogenesis, prevention, and treatment of MOH. We suggest that information and education about the risk of MOH is important since the condition is preventable. Most patients experience reduction of headache days and intensity after successful treatment. The first step in the treatment of MOH should be carried out in primary care and focus primarily on withdrawal, leaving prophylactic medication to those who do not manage primary detoxification. For most patients, a general practitioner can perform the follow-up after detoxification. More complicated cases should be referred to neurologists and headache clinics. Patients suffering with MOH have much to gain by an earlier treatment-focused approach, since the condition is both preventable and treatable.

Neurovascular contributions to migraine: Moving beyond vasodilation

“…They possess vasoconstrictive properties and therefore are generally not prescribed in patients with cardiovascular disease or abnormal blood pressure (Dodick et al, 2004). Moreover, repeated dosing with triptans can lead to a phenomenon known as medication-overuse headache (MOH) (Kristoffersen and Lundqvist, 2014). MOH is characterized as a headache occurring on more than 15 days per month with regular overuse (more than 3 months) of one or more drugs that can be taken for acute and/or symptomatic treatment of headache (Headache Classification Committee of the International Headache Society, 2013).…”

Headache in Children and Adolescents

“…Adolescents with headache often prefer taking analgesics themselves and overuse it, than visiting a physician. Medication overuse headache (MOH) had become a worldwide health problem with a prevalence of 1-2%, and is refractory to most of the available treatment options [40] .…”

“…This can be worsened by using ineffective and under-dose medications or misdiagnosing the headache. It can be managed by withdrawal of overused medication and review and reassessing the underlying primary headache disorder [40] .…”

Meningeal Afferent Signaling and the Pathophysiology of Migraine

“…18 Opioids coupled with NSAIDs or acetaminophen, as well as barbiturates are also used by migraine patients, even though they too can induce MOH. 25,26 As mentioned above, prophylactic migraine treatment is given on a daily basis in order to attempt to prevent the onset of migraine attacks or decrease frequency. Commonly used prophylactic agents are antiepileptics, such as topiramate, gabapentin, or valproate, beta blockers such as propranolol, or antidepressants such as amitriptyline.…”