Medication-overuse headache: a widely recognized entity amidst ongoing debate

Abstract

Medication overuse in primary headache disorders is a worldwide phenomenon and has a role in the chronification of headache disorders. The burden of disease on individuals and societies is significant due to high costs and comorbidities. In the Third Edition of the International Classification of Headache Disorders, medication-overuse headache is recognized as a separate secondary entity next to mostly primary headache disorders, although many clinicians see the disease as a sole complication of primary headache disorders. In this review, we explore the historical background of medication-overuse headache, its epidemiology, phenomenology, pathophysiology and treatment options. The review explores relevant unanswered questions and summarizes the current debates in medication-overuse headache.

Persistent Post-Traumatic Headache and Migraine: Pre-Clinical Comparisons

“…The combination treatment showed an efficacy of 79%, 61% for the ibuprofen group, 33% in the acetaminophen group and 21% in the standard care group. However, the use of NSAIDs drugs should be limited in order to reduce the possible risk of incurring in medication overuse (MO), while acetaminophen is used in subjects where the use of these drug treatment is not recommended [54].…”

The Many Faces of Medication‐Overuse Headache in Clinical Practice

“…The pathophysiology of MOH is incompletely understood. The development of MOH is associated with a background of a primary headache disorder, frequent intake of analgesics, increasing frequency of headaches, psychological and personality traits, and genetic predisposition 24,25 . Genes involved in pain, drug‐dependence, metabolic, serotonergic, and dopaminergic pathways have been linked to MOH 24‐28 .…”

“…The development of MOH is associated with a background of a primary headache disorder, frequent intake of analgesics, increasing frequency of headaches, psychological and personality traits, and genetic predisposition 24,25 . Genes involved in pain, drug‐dependence, metabolic, serotonergic, and dopaminergic pathways have been linked to MOH 24‐28 . Interestingly, regular use of analgesics for a non‐headache indication is associated with the development of chronic headache, specifically in migraine patients 29,30 .…”

Migraine Headache: Updates and Future Developments

“…Medication overuse headache is defined as a headache occurring at least 15 days per month in patients with preexisting headache disorders and with concurrent use of either simple analgesic agents such as ibuprofen or naproxen at least 15 days per month or other analgesic agents such as triptans or ergotamines 10 days per month for at least 3 months. 17 Although withdrawal and reduction of abortive medications is considered to be the treatment, there is no standard practice recommended at this time. 6 Unfortunately, most patients are unaware of the risks of excessive drug intake, so providers should be diligent in evaluating the frequency of analgesic use.…”

“…6 Unfortunately, most patients are unaware of the risks of excessive drug intake, so providers should be diligent in evaluating the frequency of analgesic use. 17,18 With the rise of complementary and alternative medicine worldwide, an increasing number of supplements and vitamins have been touted as effective migraine treatments. Many of these treatments have shown benefit, leading to varying degrees of endorsement in migraine guidelines for butterbur, feverfew, coenzyme Q10, and others.…”