Medication Overuse Headache

The most common causes of medication overuse headache are overuse of the following:

Overuse of other nonsteroidal anti-inflammatory drugs (NSAIDs) and ergotamine can also cause this disorder.

An overly sensitive nervous system is thought to cause medication overuse headache. That is, the nerve cells in the brain that trigger pain are too easily stimulated.

Substance dependence Substance Use Disorders Substance use disorders generally involve behavior patterns in which people continue to use a substance (for example, a recreational drug) despite having problems caused by its use. The substances... read more is more common among people with medication overuse headaches. They may also have a genetic predisposition to develop medication overuse headache.

Medication overuse headaches occur daily or nearly daily and are often present when people first wake up. The location and type of pain vary from person to person. People may also feel nauseated, become irritable, and have difficulty concentrating.

Doctors base the diagnosis of medication overuse headache on how often people who are regularly taking headache medications have headaches and on how often people take the headache drugs.

Medication overuse headache is diagnosed when all of the following are present:

Rarely, computed tomography (CT) or magnetic resonance imaging (MRI) is done to exclude other disorders.

Usually, doctors first give the person a preventive medication to treat the original headache disorder. The overused medication is stopped later, often abruptly. However, if people are taking high doses of opioids, barbiturates, or benzodiazepines, the amount of the overused medication is gradually decreased, over 2 to 4 weeks. Sometimes people can be treated as outpatients when the medication is stopped. However, people with headache due to opioid overuse are hospitalized. Stopping these medications more abruptly can cause symptoms such as nausea, restlessness, anxiety, and poor sleep. Stopping any kind of pain reliever can cause headaches to occur more often, last longer, and become more intense. Symptoms after stopping a medication may last a few days or up to 4 weeks.

A transitional medication is used to treat headaches that occur after stopping the overused medication.

Transitional (bridge) medications are used to help prevent headache symptoms of withdrawal if stopping the overused medication causes too many, sometimes dangerous symptoms The transitional drug should be a different type of headache medication from the one that caused the overuse headache. Doctors limit use of transitional medications to less than twice a week if possible.

Transitional drugs (see table Some Medications Used to Treat Migraines Some Drugs Used to Treat Migraines ) include the following:

After medication overuse disorder has been treated, people are instructed to limit their use of all rescue and transitional headache medications used to stop (abort) headaches as follows:

Medications used to prevent headaches should be continued as prescribed.

Doctors encourage people to keep a headache diary. In it, people write down the number and timing of attacks, possible triggers, and their response to treatment. With this information, triggers may be identified and eliminated when possible. Then, people can participate in their treatment by avoiding triggers, and doctors can better plan and adjust treatment.

Biofeedback Biofeedback Biofeedback, a type of mind-body medicine, is a method of bringing unconscious biologic processes under conscious control. In biofeedback, electronic devices are used to measure and report information... read more and other cognitive techniques Mind-Body Medicine Complementary or alternative medicine can be classified into five major categories of practice: Whole medical systems Mind-body techniques Biologically based practices Manipulative and body-based... read more (such as relaxation training, hypnosis, and stress management) can help people control, reduce, or cope with their headaches by changing the way they focus their attention. Biofeedback enables people to control the pain.

People are counseled to avoid using previously overused medications. They are also taught and encouraged to adopt healthy lifestyle habits.

With treatment, the pain disappears (goes into remission) in about 50% of people after 10 years. People with migraines tend to do better than those with tension-type headaches.

People who have fewer headache days a month after 1 year of treatment tend to stay in remission longer.