Medication overuse headache: an overview of clinical aspects, mechanisms, and treatments

Krymchantowski, Abouch Valenty; Jevoux, Carla; Krymchantowski, Ana Gabriela; Vivas, Rodrigo Salvador; Silva‐Néto, Raimundo Pereira

doi:10.1080/14737175.2020.1770084

Cited by 23 publications

(50 citation statements)

References 74 publications

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“…In the PROMISE‐2 clinical trial, investigators avoided advising or educating patients about MOH to avoid a placebo response. Geographic differences in healthcare systems, variations in AHM prescribing, referral pathways, and access to headache specialists also add to the complexity of managing MOH, and may impact patient outcomes 9,33 . Furthermore, patients who overuse centrally acting analgesics, such as codeine preparations or opioids, commonly display the characteristics of substance dependence, 34 which makes successful reduction or withdrawal of AHM less likely.…”

Section: Discussionmentioning

confidence: 99%

“…An unmet need clearly exists to prevent MOH from developing, which may be achieved by using new treatments with high levels of sustained efficacy, high tolerability, and delivery methods that improve patient adherence to treatment. 9 Eptinezumab is a humanized IgG1 monoclonal antibody that selectively binds to and durably inhibits the calcitonin gene-related peptide (CGRP) ligand with high affinity. [10][11][12] Eptinezumab is approved in the United States for the preventive treatment of migraine in adults.…”

Section: Introductionmentioning

confidence: 99%

“…Those abnormalities associated with pain appear to return to normal after MOH is resolved, but the areas associated with addiction may still be abnormal. An unmet need clearly exists to prevent MOH from developing, which may be achieved by using new treatments with high levels of sustained efficacy, high tolerability, and delivery methods that improve patient adherence to treatment 9 …”

Section: Introductionmentioning

confidence: 99%

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Preventive migraine treatment with eptinezumab reduced acute headache medication and headache frequency to below diagnostic thresholds in patients with chronic migraine and medication‐overuse headache

et al. 2021

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Objective: This post hoc analysis in patients medically diagnosed with chronic migraine (CM) and medication-overuse headache (MOH) evaluated reductions in the use of acute headache medication (AHM) and sustained changes in the diagnostic status of CM and MOH following eptinezumab treatment in the PROMISE-2 study.Background: Eptinezumab, a monoclonal antibody that inhibits calcitonin generelated peptide, is approved in the United States for the preventive treatment of migraine. A previous analysis showed that eptinezumab reduced monthly migraine days and was well tolerated in the subgroup of PROMISE-2 patients diagnosed with both CM and MOH. Methods:The phase 3, double-blind, placebo-controlled PROMISE-2 study (NCT02974153) randomized adults with CM to eptinezumab 100 mg, 300 mg, or placebo (administered intravenously every 12 weeks for up to two doses). MOH was prospectively diagnosed at screening by trained physicians based on 3 months of medication history and International Classification of Headache Disorders-3β criteria. This post hoc analysis evaluated changes in total and class-specific days of AHM usage, the percentage of patients using AHM at or above MOH diagnostic thresholds, and the percentage of patients experiencing monthly headache and migraine day frequency below diagnostic thresholds for MOH and/or CM. Results:In PROMISE-2, 431/1072 (40.2%) patients with CM were diagnosed with MOH (eptinezumab 100 mg, n = 139; 300 mg, n = 147; placebo, n = 145) and were

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preventive migraine treatment with eptinezumab reduced acute headache medication and headache frequency to below diagnostic thresholds in patients with chronic migraine and medication‐overuse headache

et al. 2021

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“…The mechanism behind the development and maintenance of MOH is not well understood 29 . Effective migraine therapies that can help reduce the risk of MOH and treat existing MOH is much needed.…”

Section: Discussionmentioning

confidence: 99%

Medication overuse headache in patients with chronic migraine using cannabis: A case–referent study

Zhang

Woldeamanuel

2021

Headache

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Objective To examine whether cannabis use predicts medication overuse headache (MOH) in patients with chronic migraine (CM). Methods Electronic chart review was conducted by combining the terms “CM,” “medication overuse,” “cannabis,” “cannabidiol,” and “tetrahydrocannabinol” for patients seen at our headache clinics from 2015 to 2019. Of 729 charts consecutively screened, 368 met our inclusion criteria, that is, adult patients with CM with ≥1‐year CM duration. The following variables were extracted from the included patient charts: MOH diagnosis, age, sex, migraine frequency, current CM duration, current cannabis use duration, overused acute migraine medications, current MOH duration, and types of cannabis products used. Logistic regression was used to identify variables predicting MOH while controlling for remaining predictors. Agglomerative hierarchical clustering (AHC) was conducted to explore natural clusters using all predictor variables. Results There were 212 patients with CM and MOH (cases; median age 43 years, interquartile range [IQR] 33–54; 177 [83%] females) and 156 patients with CM without MOH (referents; median age 40 years, IQR 31–49; 130 [83%] females). MOH was present in 81% (122/150) of current cannabis users compared with 41% (90/218) in those without cannabis use—adjusted odds ratio 6.3 (95% CI: 3.56 to 11.1, p < 0.0001). Current cannabis use was significantly associated with opioid use (Spearman's rho 0.26, p < 0.0001). Both current cannabis use (rho 0.40, p < 0.0001) and opioid use (rho 0.36, p < 0.0001) were significantly associated with MOH. Similarly, AHC revealed two major natural clusters. Cluster I patients featured 9.3 times higher current cannabis use, 9.2 times higher current opioid use, and 1.8 times higher MOH burden than those in Cluster II (p < 0.0001). Conclusion Cannabis use was significantly associated with increased prevalence of MOH in CM. Bidirectional cannabis–opioid association was observed—use of one was associated with use of the other. Advising patients with CM and MOH to reduce cannabis use may help treat MOH effectively.

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“…Entretanto, nem todas as pessoas com migrânea desenvolvem quadro crônico de cefaleia decorrente do uso excessivo de medicamentos 16 . É válido lembrar também que pacientes com cefaleia episódica podem desenvolver CEM caso usem medicação para dor por outras causas, como artrite, embora a dor que motivou a tomada de medicamentos não piore 17 .…”

Section: Clínicaunclassified

Bloqueio Nervoso Periférico Como Tratamento Cirúrgico Para Dor De Cabeça De Uso Excessivo De Medicamentos: Dois Relatórios De Caso

Fonseca¹,

Neves²,

Silva³

2022

RECISATEC

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Dor de cabeça de uso excessivo de drogas (EMC) é uma dor de cabeça secundária que ocorre por 15 ou mais dias por mês em pacientes com diagnóstico pré-existente de dor de cabeça primária, o que leva ao consumo excessivo regular de medicamentos sintomáticos de dor de cabeça por 10 dias em casos de ergotamina, tripulações, opioides e combinações de analgésicos, ou por mais de 15 dias em casos de analgesics não opioides, ou por mais de 15 dias em casos de analgesics não opioides, ou por mais de 15 dias em casos de analgesics não opioides, ou por mais de 15 dias em casos de analgesics não opioides, ou por mais de 15 dias em casos de analgesics não opioides, ou por mais de 15 dias em casos de analgesics não opioides, ou por mais de 15 dias em casos de analgesics não opioides, ou por mais de 15 dias em casos de analgesics não opioides, ou por mais de 15 dias em casos de angesics não opioides, paracetamol e anti-inflamatórios não esteroides por mês por mais de 3 meses. O CEM é uma das doenças incapacitantes que teve a maior incidência desde a década de 1990. A principal medida terapêutica é a retirada do medicamento superusuado. No entanto, alguns pacientes não respondem totalmente ao protocolo de retirada e, além disso, aqueles que apresentaram melhora, ainda têm dores de cabeça mensais, embora suficientes para não serem diagnosticados com EMF. Os blocos anestésicos são um recurso para o gerenciamento de diferentes dores de cabeça, seja como tratamento isolado ou combinado, ou para o tratamento da dor de cabeça de recuperação após a retirada de medicamentos. Os anestésicos locais são capazes de interromper reversivamente a condução do impulso nervoso bloqueando canais de sódio dependentes de tensão através de sua fração não ionizada, reduzindo assim a excitabilidade celular. Assim, este estudo teve como objetivo relatar o uso do bloqueio nervoso periférico como um tratamento alternativo e eficaz para o MOH.

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Medication overuse headache: an overview of clinical aspects, mechanisms, and treatments

Cited by 23 publications

References 74 publications

Preventive migraine treatment with eptinezumab reduced acute headache medication and headache frequency to below diagnostic thresholds in patients with chronic migraine and medication‐overuse headache

Preventive migraine treatment with eptinezumab reduced acute headache medication and headache frequency to below diagnostic thresholds in patients with chronic migraine and medication‐overuse headache

Medication overuse headache in patients with chronic migraine using cannabis: A case–referent study

Bloqueio Nervoso Periférico Como Tratamento Cirúrgico Para Dor De Cabeça De Uso Excessivo De Medicamentos: Dois Relatórios De Caso

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