Medication Overuse Headache Successfully Treated by Three Types of Japanese Herbal Kampo Medicine

Abstract

Medication overuse headache (MOH) usually resolves after the overuse is stopped and starting prophylactic medications. However, it can be challenging to prescribe common prophylactic medications when patients have a history of side effects. As an alternative therapy, traditional Japanese herbal kampo medicine can be used. We herein report a case of a MOH woman with a history of side effects by such common prophylactic medications. A 50-year-old woman presented with a severe migraine attack. She had suffered from migraines for 10 years. She had taken loxoprofen and sumatriptan every day for over eight years. As prophylactic medications, lomerizine, valproic acid, and amitriptyline had been prescribed in the past, but they were discontinued due to side effects. Therefore, she could continue only propranolol as prophylactic medication. She had severe pulsatile headaches and nausea every day. We diagnosed triptan-and nonsteroidal anti-inflammatory drug-overuse headache (the International Classification of Headache Disorders 3rd edition code 8.2.2 and 8.2.3.2) and chronic migraine (code 1.3). She was admitted and stopped loxoprofen and sumatriptan. We prescribed three types of Japanese herbal kampo medicines -kakkonto (TJ-1), goreisan (TJ-17), and goshuyuto (TJ-31). Her headache was relieved on day 5, and she was discharged on day 7. In the 40 days after discharge, she had only three times mild headaches with a numeric rating scale (NRS) of 2/10. She did not need any triptans nor anti-inflammatory drugs. We herein presented the MOH woman who was successfully treated using three types of kampo medicine. We should pay attention to their side effects, but kampo medicine may be useful for MOH treatment as acute and prophylactic medications for primary headaches.

Spontaneous Intracranial Hypotension Manifesting Orthostatic Headache Worsened by Playing the Saxophone and Treated by Japanese Herbal Kampo Medicine Goreisan

“…This is because shin-eki (all the fluid in the body) includes CSF, and suidoku means the shin-eki' s excess, reduction, and dislocation [ 5 , 6 ]. Goreisan is used to relieve headaches caused by suidoku , and it may work by inhibiting the water channel aquaporin-4 (AQP4) [ 8 ]. The glymphatic system in the brain is a fluid clearing mechanism.…”

“…If the swollen astrocyte endfeet shut the PVS, CSF circulation is disrupted [ 10 ]. Kampo medication Goreisan is thought to increase glymphatic flow by inhibiting AQP4 and thereby enabling CSF circulation by shrinking astrocyte endfeet and resolving PVS closure [ 8 ]. Although it is only a guess, increased CSF circulation could have rectified the excess CSF that had seeped through the dura.…”

“…She wanted to continue playing saxophone and did not want to be admitted. Therefore, we prescribed 7.5 g of Japanese herbal Kampo medicine Goreisan to treat suidoku status (fluid disturbance such as edema, dehydration, and dislocation) [ 5 , 6 , 8 ] in three divided doses. The headache severity slightly improved over one month.…”

Spontaneous Intracranial Hypotension Manifesting Orthostatic Headache Worsen by Playing the Trombone

“…We did not perform a more accurate modality for leakage localization, such as computed tomography-myelography, considering the radiation exposure and her young age. We prescribed 7.5 g of Japanese herbal Kampo medicine Goreisan to treat suidoku status (fluid disturbance such as edema, dehydration, and dislocation) via inhibiting aquaporin-4 channels [ 4 ]. The headache severity slightly improved but continued.…”

Medication Overuse Headache Successfully Treated by Japanese Herbal Kampo Medicine, Yokukansan

“…We previously reported the efficacy of combined Kampo medicine treatment for a woman with MOH. The patient's migraine was associated with weather, menopause, and muscle tension, so we prescribed goreisan (TJ-17), goshuyuto (TJ-31), and kakkonto (TJ-1) for each characteristic of the headache [11]. Goreisan (TJ-17) may activate the glymphatic flow correctly and promote the drainage of inflammatory substances by regulating the aquaporin 4 channel, thereby suppressing the headache [12,13].…”