Preventing and treating medication overuse headache

Alstadhaug, Karl Bjørnar; Ofte, Hilde Karen; Kristoffersen, Espen Saxhaug

doi:10.1097/pr9.0000000000000612

Cited by 31 publications

(26 citation statements)

References 31 publications

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“…Medication overuse headache, linked to overuse of attack aborting medication, is an important consideration with patients presenting to the specialist headache clinic. Its prevalence in the general adult population of different countries ranges from 0.5% to 7.6% . In patients with chronic daily headache, its prevalence may be as high as 11‐70% .…”

Section: Epidemiologymentioning

confidence: 99%

Migraine Burden of Disease: From the Patient's Experience to a Socio‐Economic View

2018

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Migraine is one of the most common diseases worldwide and, importantly, a major cause of disability. This translates into a huge clinical and economic burden to individuals and society. Despite existing data on how migraine affects populations, the disease continues to be underdiagnosed and therefore undertreated, so the scale of the public health problem may be underestimated. The impact on the daily lives of patients and their families has also been underappreciated. Clinical and regulatory guidelines are encouraging the use of patient-reported outcome tools (PROs), as these may help in disease management and facilitate physician-patient interactions. In clinical trials in migraine, PRO data are key to evaluating the effects of new therapies on patients, such as disability assessment, productivity, quality of life, and emotional and physical functioning. Digital technologies have enabled the development of ePRO tools, which may play a growing role in the collection of PRO data in the future. Here, we will consider the current view of the burden imposed by migraine on patients and society, illustrate this with two patient case studies, and examine the initiatives underway to use our knowledge to improve our management approaches for the disease.

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Section: Epidemiologymentioning

confidence: 99%

Migraine Burden of Disease: From the Patient's Experience to a Socio‐Economic View

2018

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“…Analgesic consumption must be carefully evaluated. Frequent use of all types of pain-relieving drugs, in particular triptans, ergotamine, opioids, caffeine, meprobamate and codeine-containing products, may be associated with rebound headache, which itself is associated with greater pain-related disability 53,54. Withdrawal of treatment often leads to improvement and evolution to episodic headache.…”

Section: Practical Approach To Pain Management In Chronic Pain Of Uncmentioning

confidence: 99%

<p>Practical approach to a patient with chronic pain of uncertain etiology in primary care</p>

Salduker¹,

Allers²,

Bechan

et al. 2019

JPR

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Chronic pain of uncertain etiology often presents a challenge to both patients and their health care providers. It is a complex condition influenced by structural and physiological changes in the peripheral and central nervous systems, and it directly influences, and is modulated by, psychological well-being and personality style, mood, sleep, activity level and social circumstances. Consequently, in order to effectively treat the pain, all of these need to be evaluated and addressed. An effective management strategy takes a multidisciplinary biopsychosocial approach, with review of all current medications and identification and careful withdrawal of those that may actually be contributing to ongoing pain. The management approach is primarily nonpharmacological, with carefully considered addition of medication, beginning with pain-modulating treatments, if necessary. In this article, we present a primary care approach to the assessment and management of a patient with chronic pain where the cause cannot be identified.

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“…Opioids are included in this rationale to be consistent with the International Classification of Headache Disorders regarding medication overuse). It has been suggested that clinicians consider preventive treatments in these populations . Although there are no data on this topic in pediatric populations, it is hypothesized that similar relationships between frequent headache, medication overuse, and progression to chronic migraine may occur in children.…”

Section: Practice Recommendationsmentioning

confidence: 99%

Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention

et al. 2019

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Objective To provide updated evidence‐based recommendations for migraine prevention using pharmacologic treatment with or without cognitive behavioral therapy in the pediatric population. Methods The authors systematically reviewed literature from January 2003 to August 2017 and developed practice recommendations using the American Academy of Neurology 2011 process, as amended. Results Fifteen class I‐III studies on migraine prevention in children in adolescents met inclusion criteria. There is insufficient evidence to determine if children and adolescents receiving divalproex, onabotulinumtoxinA, amitriptyline, nimodipine and flunarizine are more or less likely than those receiving placebo to have a reduction in headache frequency. Children with migraine receiving propranolol are possibly more likely than those receiving placebo to have an at least 50% reduction in headache frequency. Children and adolescents receiving topiramate and cinnarizine are probably more likely than those receiving placebo to have a decrease in headache frequency. Children with migraine receiving amitriptyline plus cognitive behavioral therapy are more likely than those receiving amitriptyline plus headache education to have a reduction in headache frequency. Recommendations The majority of randomized controlled trials studying the efficacy of preventive medications for pediatric migraine fail to demonstrate superiority to placebo. Recommendations for the prevention of migraine in children include counseling on lifestyle and behavioral factors that influence headache frequency, and assessment and management of comorbid disorders associated with headache persistence. Clinicians should engage in shared decision making with patients and caregivers regarding the use of preventive treatments for migraine, including discussion of the limitations in the evidence to support pharmacologic treatments.

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Preventing and treating medication overuse headache

Abstract: Medication overuse headache is a secondary headache—a worsening of a pre-existing headache (usually a primary headache) owing to overuse of one or more attack-aborting or pain-relieving medications.

Cited by 31 publications

References 31 publications

Migraine Burden of Disease: From the Patient's Experience to a Socio‐Economic View

Migraine Burden of Disease: From the Patient's Experience to a Socio‐Economic View

<p>Practical approach to a patient with chronic pain of uncertain etiology in primary care</p>

Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention

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