Medication-overuse headache MOH is a frequent diagnosis in neurology and headache clinics. The term basically implies the generation or worsening of chronic headache resulting from excessive use of medications used for the acute rescue of headache.
Most headache rescue medications including not-steroidal anti-inflammatories (like Ibuprofen), Acetaminophen, Triptans (like sumatriptan and rizatriptan), opioids and combination medications (i.e. the ones containing multiple medications inside of them, especially the ones have caffeine or bultabital) are implicated of causing MOH.
Medication-overuse headache was identified in 1980s when it became clear that some migraine patients transform from having intermittent migraine (called episodic migraine) to chronic daily headache in the setting of certain factors, including the excessive use of analgesics. The withdrawal of these analgesics resulted in improvement of these headaches without any further therapy.
In early 2000s, medication-overuse headache was officially recognized as a clinical entity. Using large epidemiological studies, it was defined as a chronic headache that occurs in patients who utilize analgesics for more than 10-15 days a month (depending on the analgesic type, some are 10 days a month and some are 15).
As you can imagine, this definition is quite broad, and basically resulted in most patients who have frequent headaches to be classified as suffering MOH. However, it is important to keep few things in mind:
Medication overuse headache can only affect patients who originally have headaches, especially migraine People without headache do not suffer medication-overuse headache from daily use of analgesics in general. This explain why patients with arthritis and back pain for example can be using Ibuprofen or other pain medications on daily basis, and yet not necessarily have headaches.
Medication overuse does not equate medication overuse headache Most patients who utilize daily pain medications for their headache do it because their original headache is severe and resistant to treatment. However, that does not mean every patient who uses medication more than 10-15 times a month has a medication overuse headache. Many patients have been utilizing analgesics more than that, and yet remain controlled and able to function.
Medication overuse is not addiction It is very frustrating when doctors treat medication-overuse headache as if it is the patient's fault. The daily use of pain medications in migraine is not because of the psyhological graving for it. It is mainly because these medications impairs our brain's natural brake systems against pain, hence making the patients more prone to suffer more from their headaches. However keep in mind that some medications can cause both, addiction and medication-overuse headache, such as opioids.
Medication withdrawal is not always the treatment We have encountered numerous patients in our practice who were denied treatment for their headache until they can stop the medication that is suspected to cause MOH. This can be brutal at times. It is established that preventative treatments for headache can reverse MOH, even without deliberately trying to stop the medication. In another word, even if a patient has a diagnosis of medication-overuse headache, some migraine treatments can cause the headache to remit substantiually, that the patient can stop the use of problematic medication on their own without any "withdrawal period". This has been especially true with the new class of medications, called CGRP-antagonists (more on that in another post).
The bottom line, if you are finding yourself needing more than 10-15 rescue treatments a month, then your migraine is not under control, and something should be done about it. If nothing is attempted, you will find yourself only increasing the number of pills you take a month, and increasing your migraine resistance to other treatments.
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