Breaking the cycle of medication overuse headache

  title={Breaking the cycle of medication overuse headache},
  author={Stewart J. Tepper and Deborah E Tepper},
  journal={Cleveland Clinic Journal of Medicine},
  pages={236 - 242}
When patients who have frequent, disabling migraines take medications to relieve their symptoms, they run the risk that the attacks will increase in frequency to daily or near-daily as a rebound effect comes into play. This pattern, called medication overuse headache, is more likely to happen with butalbital and opioids than with migraine-specific drugs, as partial responses lead to recurrence, repeat dosing, and, eventually, overuse. Breaking the cycle involves weaning the patient from the… 

Treatment of Medication Overuse Headache

A worsening and transformation of episodic migraine into daily or near-daily headache, associated with overuse of acute anti-migraine medications, is defined.

Clinical Aspects of Medication Overuse Headaches

Medication overuse headache (MOH) is a subset of chronic daily headache, occurring from overuse of 1 or more classes of migraine abortive medication. Acetaminophen, combination analgesics (caffeine

Medication Overuse Headache Due to Butalbital, Acetaminophen, and Caffeine Tablets

  • R. Feeney
  • Medicine, Psychology
    Journal of pain & palliative care pharmacotherapy
  • 2016
ABSTRACT Questions from patients about pain conditions and analgesic pharmacotherapy and responses from authors are presented to help educate patients and make them more effective self-advocates.

Medication overuse headaches.

  • B. Abrams
  • Medicine, Psychology
    The Medical clinics of North America
  • 2013

The treatment of migraine headaches in children and adolescents.

  • M. BrennerD. Lewis
  • Medicine, Psychology
    The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG
  • 2008
There is limited controlled data to provide a comprehensive, evidence-based guideline, however, the most rigorously studied agents for acute treatment are ibuprofen, acetaminophen, and "triptan" nasal spray forms of sumatriptan and zolmitriptan; all of these have shown safety and efficacy in controlled trials.

The paradoxical effects of analgesics and the development of chronic migraine.

  • M. Bigal
  • Psychology, Medicine
    Arquivos de neuro-psiquiatria
  • 2011
The issue of causality is discussed and evidence suggesting that specific medications, at critical doses, are risk factors for chronic migraine (CM) is reviewed, and the concept of critical dose of exposure for different classes is presented.

Medical Treatment of Chronic Daily Headaches: Chronic Migraine, Chronic Tension-Type Headaches, New Daily Persistent Headaches, Hemicrania Continua, and Medication Overuse Headache

The resistant medication overuse headache, chronic migraine, new daily persistent headache, and chronic tension-type headache patients often need a more intensive program that is interdisciplinary in

Medical Treatment of Refractory Daily Headaches, Including Interdisciplinary Management

This chapter explores the medical treatment of chronic daily headache and suggests that successful treatment of refractory chronic headache patients is possible with an interdisciplinary approach.


Migraine may bring a suffering phase in an individual's schedule yet it can be handled with the familiarity of some self-care remedies and by making simple modifications in the routine lifestyle, which may facilitate to pave the clear way to recovery and make things easier for migraine management.



Analgesic/abortive overuse and misuse in chronic daily headache

The frequent use of medication for the treatment of acute migraine attacks may cause medication overuse headache, which can be caused by the intake of combination analgesics, opioids, ergot alkaloids, and triptans.

Daily pharmacologic prophylaxis of episodic migraine

Migraine-preventive medications, at best, work in approximately half of patients to reduce migraine frequency by about 50%, so careful establishment of expectations with use of headache diaries is crucial for therapeutic success.

Rates and predictors for relapse in medication overuse headache: A 1-year prospective study

The authors prospectively studied 98 patients with medication overuse headache and found the 1-year relapse rate was lower for patients with migraine compared with tension-type headache and combination of migraine and tension- type headache than for patients overusing triptans or ergots.

Medication Overuse Headache: Clinical Features Predicting Treatment Outcome at 1-Year Follow-Up

Multivariate analysis determined the frequency of primary headache disorder, ergotamine overuse and disability of chronic headache estimated by MIDAS as independent predictors of treatment efficacy at 1-year follow-up.

Topiramate Reduces Headache Days in Chronic Migraine: A Randomized, Double-Blind, Placebo-Controlled Study

This randomized, double-blind, placebo-controlled trial demonstrates that topiramate is effective and reasonably well tolerated when used for the preventive treatment of chronic migraine, even in the presence of medication overuse.

Drug-Induced Headache: Long-Term Follow-Up of Withdrawal Therapy and Persistence of Drug Misuse

The data show a higher relapse rate than previously assumed and that certain substance groups bear aHigher relapse risk.

Chronic Daily Headache

Determining the usual duration (greater or less than 4 hours) of individual headache episodes will refine the differential diagnosis in patients with primary CDH, and evidence-based treatment strategies are discussed.

New Appendix Criteria Open for a Broader Concept of Chronic Migraine

The International Headache Classification Committee has worked out the more inclusive criteria for CM and MOH and it is now recommended that the MOH diagnosis should no longer request improvement after discontinuation of medication overuse but should be given to patients if they have a primary headache plus ongoing medication over use.

Long-Term Follow-Up of Patients Treated for Chronic Headache with Analgesic Overuse

At 4 years of follow-up, only one-third of patients initially treated for chronic daily headache and analgesic overuse are successful in refraining from chronic overuse, and subjects appear to have a persistence for combination analgesic agents; however, their QoL is slightly better than that of patients who revert to episodic headache or continue with chronic daily headaches but do not overuse analgesic agent.