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.)
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.
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 is more common among people with medication overuse headaches. They may also have a genetic predisposition to develop medication overuse headache.
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.
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) include
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:
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 and other cognitive techniques (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.