Medication Overuse Headache

The most common medications taken by patients with medication overuse headache are

Other nonsteroidal anti-inflammatory drugs (NSAIDs) can also cause medication overuse headache.

The mechanism of medication overuse headache is thought to include sensitization of the central nervous system similar to what occurs in migraine.

A greater prevalence of substance dependence in people with medication overuse headache suggests a behavioral component. A genetic predisposition may also be involved.

Headache occurs daily or nearly daily, often on awakening. Nausea, irritability, and difficulty concentrating may be present. Location and characteristics of the pain vary.

Diagnosis of medication overuse headache is clinical and is based upon the frequency of headache and use of medications to relieve it.

According to the International Classification of Headache Disorders (1 Diagnosis references Medication overuse headache is a chronic headache that occurs > 15 days/month in patients who regularly overuse headache medication for > 3 months. It usually develops in people with migraine... read more , 2 Diagnosis references Medication overuse headache is a chronic headache that occurs > 15 days/month in patients who regularly overuse headache medication for > 3 months. It usually develops in people with migraine... read more ), the criteria for the diagnosis of medication overuse headache include

Medication overuse headache must be differentiated from the primary headache disorder, which typically causes concurrent symptoms.

Rarely, CT or MRI is done to exclude other disorders. Routine neuroimaging is unnecessary.

A patient with medication overuse headache can be treated in an outpatient or inpatient setting; sometimes IV medications are required. Patients with headache due to opioid overuse should be treated in an inpatient setting.

Preventive medications Prevention Migraine is an episodic primary headache disorder. Symptoms typically last 4 to 72 hours and may be severe. Pain is often unilateral, throbbing, worse with exertion, and accompanied by symptoms... read more (eg, topiramate, onabotulinumtoxinA, erenumab, epitinezumab, fremanezumab, galcanezumab) are usually started first, and the overused medication is later stopped, often abruptly; the exception is patients who are taking high doses of opioids, barbiturates, or benzodiazepines; for these patients, the medication may need to be tapered more gradually (over 2 to 4 weeks).

Early symptoms after stopping opioids, barbiturates, or benzodiazepines include nausea, restlessness, anxiety, and poor sleep. In addition, stopping any kind of analgesic can cause an increase in the frequency, duration, and/or intensity of headaches. These symptoms may last a few days or up to 4 weeks.

A rescue medication is used to treat withdrawal headache; rescue medications are the same as transitional medications.

Transitional (bridge) medications are used to help prevent withdrawal headache symptoms if withdrawal of the overused medication, use of the rescue medication, and preventive medications are unlikely to be successful. Transitional medications include

After medication overuse headache has been treated, patients should be instructed to limit acute use of all headache medications as follows:

Use of previously overused medications is discouraged.

Cognitive therapy, biofeedback (eg, frontal electromyographic biofeedback), and education are helpful.

With treatment, medication overuse headache is probably in remission in about 50% of patients after 10 years.

Fewer headache days/month after 1 year of treatment predicts longer remission.