Medication overuse headache usually develops in people who have migraines or a tension-type headache.
The type of headache pain varies from person to person.
Doctors diagnose medication overuse headaches based on how often people take headache drugs and have headaches.
Doctors treat these headaches by stopping the headache drug, by prescribing a different type of headache drug to manage symptoms caused by stopping the drug, and often by prescribing drugs to treat the original headache disorder.
(See also Overview of Headache Overview of Headache A headache is pain in any part of the head, including the scalp, upper neck, face, and interior of the head. Headaches are one of the most common reasons people visit a doctor. Headaches interfere... read more .)
Medication overuse headache occurs 1 to 2% of the general population. It is more common among women than men.
Most people with this type of headache are taking headache drugs for migraines or tension-type headaches, They are taking too much of the drug or taking it too often, usually because the drug is not effectively relieving their pain.
Causes of Medication Overuse Headache
The most common causes of medication overuse headache are overuse of the following:
Opioids
Pain relievers (analgesics) that contain butalbital (a barbiturate)
Aspirin or acetaminophen taken with caffeine
Triptans (drugs that prevent and treat migraines)
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.
Symptoms of 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.
Diagnosis of Medication Overuse Headache
A doctor's evaluation
Doctors base the diagnosis of medication overuse headache on how often people who are regularly taking headache drugs have headaches and on how often people take the headache drugs.
Medication overuse headache is diagnosed when all of the following are present:
Headache occurs 15 days or more a month in people taking acetaminophen, aspirin, or another nonsteroidal anti-inflammatory drug (NSAID) or 10 days or more a month in people taking ergotamine, triptans, opioids, or combination headache drugs as treatment for a headache disorder.
People are regularly taking too much of one or more drugs to relieve the headaches and have been doing so for more than 3 months.
No other headache disorder better accounts for the symptoms.
Rarely, computed tomography (CT) or magnetic resonance imaging (MRI) is done to exclude other disorders.
Prognosis of Medication Overuse Headache
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.
Treatment of Medication Overuse Headache
A different drug to prevent the original headache (usually a migraine)
Withdrawal of the overused headache drug
Use of a different type of headache drug (rescue drug) to manage withdrawal symptoms that occur after stopping the drug
Sometimes another drug (transitional or bridging drug)
Biofeedback and cognitive techniques
Usually, doctors first give the person a different headache drug to prevent the original headache disorder . The overused drug is stopped later, often abruptly. However, if people are taking high doses of opioids, barbiturates, or benzodiazepines, the amount of the overused drug is gradually decreased, over 2 to 4 weeks. Stopping these drugs 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 drug may last a few days or up to 4 weeks.
A rescue drug is used to treat headaches that occur after stopping the overused drug. A different type of headache drug is used if possible. Doctors limit use of rescue drugs to less than twice a week if possible.
If rescue and preventive drug treatments seem unlikely to be effective at relieving symptoms, other drugs (called transitional or bridging drugs) can be given. Transitional drugs (see table Some Drugs Used to Treat Migraines Some Drugs Used to Treat Migraines 
) include
NSAIDs
A corticosteroid
Dihydroergotamine
Prochlorperazine and diphenhydramine
Clonidine (to relieve symptoms due to withdrawal when the overused drug was an opioid)
Phenobarbital (used to prevent withdrawal seizures when the overused drug was a barbiturate)
After medication overuse disorder has been treated, people are instructed to limit their use of all rescue and transitional headache drugs used to stop (abort) headaches as follows:
For NSAIDs, to fewer than 6 days a month
For triptans, ergotamine, or combinations of headache drugs, to fewer than 4 days a month
Drugs 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 drugs. They are also taught and encouraged to adopt healthy lifestyle habits.
