Update on Medication-Overuse Headache and Its Treatment

Abstract

Medication-overuse headache-i.e., a too-frequent consumption of acute headache medications leading to increased headache frequency and reduced effectiveness of acute and preventive treatments-is a serious medical condition whose pathophysiology still remains incompletely known, which is reflected into a lack of mechanism-based treatments. The first mandatory step in the therapeutic strategy remains withdrawal of the abused drug, preferably abrupt, in concomitance with a detoxification pharmacological regimen to lessen withdrawal symptoms. Intravenous hydration, antiemetics, corticosteroids (prednisone), tranquilizers (benzodiazepine), neuroleptics, and rescue medication (another analgesic than the overused) should be delivered in various combinations, on an inpatient (hospitalization and day hospital) basis or outpatient basis, depending on the characteristics of the specific patient and type of overuse. Inpatient withdrawal should be preferred in barbiturate and opioid overuse, in concomitant depression, or, in general, in patients who have difficulty in stopping the overused medication as outpatients. In contrast, in overuse limited to simple analgesics in highly motivated patients, without high levels of depression and/or anxiety, home detoxification should be chosen. Re-prophylaxis should immediately follow detoxification, ideally with local injections of onabotulinumtoxinA every 3 months or topiramate orally for at least 3 months. Adequate information to patients about the risks of a too-frequent consumption of symptomatic headache medications is essential and should constantly parallel treatment to help preventing relapse after detoxification and re-prophylaxis.

Medication‐Overuse Headache: Protocols and Outcomes in 149 Consecutive Patients in a Tertiary Brazilian Headache Center

“…Our study had the advantage of a patient population not including opioid or barbiturate overuses, and this often predicts a greater likelihood of success . Although we have had a few patients overusing benzodiazepines, they were not representative of our sample.…”

Use of Nonsteroidal Anti‐Inflammatory Drugs for Symptomatic Treatment of Episodic Headache

“…Inclusion criteria for patients in the study were: both sexes; age ≥ 18 years; and a diagnosis of (1) migraine with aura or without aura, (2) TTH, or (3) migraine plus TTH, performed according to the International Headache Society criteria (version available in the specific year of the visit, subsequently confirmed with criteria version beta of 2013) . Exclusion criteria consisted of the following: chronic forms of the selected diagnosis; medication overuse headache (MOH); any other concurrent pain condition in the cervicofacial area except migraine and/or TTH; or any other concurrent chronic pain condition at the extracervicofacial level, such as fibromyalgia, multiple myofascial pain syndromes, or chronic pelvic pain, which might involve repeated/chronic use of analgesics/NSAIDs . Informed consent to utilize the medical data in the patients' records for scientific purposes is routinely requested from patients at our Center on the occasion of their first visit, and is attached to their medical chart.…”

Botulinum neurotoxin type A for the treatment of pain: not just in migraine and trigeminal neuralgia

“…A large population-based study on the prevalence of primary headache (PH) disorders in Germany estimated that 2.6% of the general population suffer from headache ≥15 days/month, and 1.1% from chronic migraine [2]. Medication-overuse headache (MOH), i.e., chronic headache resulting from excessive consumption of pain-killers for headache, has an estimated worldwide prevalence of 0.5–7.2% [3]. Around 7% in the general population suffer from some form of chronic neuropathic pain (NP) [4].…”