Rebound-withdrawal headache (medication overuse headache)

Abstract

Rebound-withdrawal headache (medication overuse headache) is a problem that affects 1% of the population or perhaps more. Work from many countries has shown this to be a worldwide problem. It appears that the rebound-withdrawal headache often occurs on the background of pre-existing migraine or tension headache and may assume the phenotype of chronic migraine or chronic tension-type headache. The key feature of this entity is that the patient initially uses a symptomatic treatment for headache with good result. Use of this medication may increase over time, but as the use increases to more than 10 to 15 days per month, headache frequency may also increase, reaching a point where metabolic processing of the medication and removal from the system triggers another headache. The patient then finds that as use of the medication increases, the frequency and intensity of the headaches also increases, and the overall headache worsens. Once this pattern is established, therapy requires removal of the medication in order for the rebounding process to be terminated. Preventative antimigraine medications will not work in the presence of the rebound phenomenon. Once the rebound-withdrawal headache is established, it is difficult to treat. After withdrawal of the medication, there is often a high relapse rate of using the medication again with redevelopment of the rebound-withdrawal headache. Even in patients who do not relapse to drug use, headache usually remains a major problem. Recognition and treatment of rebound headache are key factors in management of these patients. Perhaps more important in regard to this entity is recognizing its existence and preventing patients from entering a pattern of rebound withdrawal, which can be achieved by early attention to their use of analgesic narcotic or migraine-abortive medications. Overall, it is likely that this will continue to be an increasing worldwide problem in managing patients with headache.

Epidemiology, Risk Factors, and Treatment of Chronic Migraine: A Focus on Topiramate

“…For example, some subjects have reported that their increases in headache frequency clearly preceded acute medication overuse. The relative contribution of acute medication overuse to the development of CM remains an open debate 38‐41 . Moreover, it has been suggested that medication overuse headache syndromes may be causally linked to migraine biology rather than be a separate entity 42 …”

“…The relative contribution of acute medication overuse to the development of CM remains an open debate. [38][39][40][41] Moreover, it has been suggested that medication overuse headache syndromes may be causally linked to migraine biology rather than be a separate entity. 42 The primary goals of preventive migraine therapies are to reduce the frequency and severity of attacks, to reduce reliance upon acute medications, and to improve patients' quality of life.…”

Past, Present, and Future Prospects of Medication‐Overuse Headache Classification

“…Since the first edition of the IHS classification, 4 the idea to classify headaches instead of patients has proved extraordinarily effective to clinical and research aims in the diagnosis of episodic headaches, but not of chronic daily headaches with medication overuse. [8][9][10][11][12][13][14][15][16][17][18][19] Indeed, Zed et al 20 in their review of English literature from 1966 to June 1998 about the treatment of medication-induced headache concluded that they had not detected rigorous clinical trials and that literature about the treatment of this complex disorder was still scant and poor. It was therefore difficult for physicians to choose the right treatment.…”

Medication overuse headache: clinical features, pathogenesis and management

“…A critical component of making the diagnosis of MOH is being certain that there is not another medical or neurologic problem to which the headache can be ascribed [Diener and Limroth, 2004; Headache Classification Committee of the International Headache Society, 2004;Young, 2004;Couch, 2006a]. A careful history must be taken and a thorough physical and neurological examination carried out to be certain that there is no organic cause for the headache that would produce a secondary headache.…”