Medication Overuse Headache: History, Features, Prevention and Management Strategies

  title={Medication Overuse Headache: History, Features, Prevention and Management Strategies},
  author={Joel R. Saper and Arnaldo Neves Da Silva},
  journal={CNS Drugs},
Medication overuse headache (MOH) is a daily, or almost daily, headache form that arises from overuse of one or more classes of migraine-abortive or analgesic medication. The main classes of drugs that cause MOH are opioids, butalbital-containing mixed analgesics, triptans, ergotamine tartrate derivatives, simple analgesics (except for plain aspirin), and perhaps non-steroidal anti-inflammatory drugs. MOH can be debilitating and results from biochemical and functional brain changes induced by… 

Medication Overuse Headache

MOH can severely impact quality of life, so it is important to identify patients who are at risk of analgesic overuse and stop the offending drug(s), rescue therapy for withdrawal symptoms and preventative therapy.

Medication overuse headache: an overview of clinical aspects, mechanisms, and treatments

This review aims at presenting MOH clinical features, pathophysiology insights, and recent knowledge and guidance regarding treatments as well as emerging treatments as monoclonal antibodies to migraine that may result in better adherence and tolerability profiles aswell as outcomes.

Medication-overuse Headache

Medication-overuse headache (MOH) is a common neurologic disorder with enormous disability and suffering and plays a significant role in the transformation from episodic to chronic headache

Medication overuse and chronic migraine: a critical review according to clinical pharmacology

This narrative review describes how to try to prevent the development of MOH and how to manage it once it has appeared, and detects disease biomarkers and predictive factors for drug response that allow for personalized treatment when migraine is still episodic and make analgesic overuse pointless.

Neuroimaging Findings in Patients with Medication Overuse Headache

Changes of brain function at similar areas have been revealed by positron emission tomography and functional magnetic resonance imaging studies, and orbitofrontal cortex is of interest, as implicated in psychological studies of MOH.

Polypharmacy Among Headache Patients: A Cross-Sectional Study

Patients with primary headaches, mainly young adults, are exposed to high polypharmacy, comparable to that of the elderly, because increased numbers of drugs increase the risk of adverse reactions, the many medications concomitantly taken by primary headache sufferers should be frequently reviewed.

Prescription pain medications and chronic headache in Denmark: implications for preventing medication overuse

High prevalence of opioid use among people with CH may be due to inappropriate headache treatment or development of MOH among those treated for other pain conditions, suggesting that migraine may be under-recognized and inappropriately treated, leading to overuse of other medications.

Inpatient Management of Migraine.

Effects of fremanezumab on the use of acute headache medication and associated symptoms of migraine in patients with episodic migraine

Fremanezumab reduced the need for acute headache medications, including migraine-specific medications, while treating migraine-associated symptoms in patients with episodic migraine.



Medication-Overuse Headache

MOH development is linked to baseline frequency of headache days per month, acute medication class ingested, frequency of acute medications ingested, and other risk factors.

Prevention and management of medication overuse headache.

Short advice on MOH is the current most cost effective management method, a method that can be applied anywhere including third world countries, and a brochure and/or the SDS should be used to prevent MOH.

Features of medication overuse headache following overuse of different acute headache drugs

Although patients overusing ergots and analgesics typically had a daily tension-type headache, patients with triptan-induced MOH were more likely to describe a (daily) migrainelike headache or an increase in migraine frequency.

Update on Medication-overuse Headache

Persistent, pronociceptive adaptations in nociceptors as well as within descending modulatory pathways thus may jointly contribute to the development of MOH.

Medication-overuse headache: similarities with drug addiction.

Medication Overuse Headache: Type I and Type II

  • J. SaperA. Lake
  • Psychology, Medicine
    Cephalalgia : an international journal of headache
  • 2006
It would serve both treatment strategy development and treatment outcome success to classify MOH into two subtypes, type I and type II, which would assist in proper triage and the development of the most effective treatment strategies.

Opiate-Induced Persistent Pronociceptive Trigeminal Neural Adaptations: Potential Relevance to Opiate-Induced Medication Overuse Headache

Preclinical studies exploring the neuroadaptive changes following sustained exposure to morphine may give some insights into possible causes of medication overuse headache.


  • J. Wilson
  • Medicine, Psychology
    Annals of Internal Medicine
  • 2007
Although migraines can be highly disruptive to daily life, effective behavioral and drug treatments can prevent attacks or relieve symptoms and clinicians should exclude secondary causes of headache.

Medication-overuse headache: where are we now?

Recent data provide better insight into pathophysiology of medication-overuse headache and the necessity of establishing a predictive model for early recognition of patients at high risk to intervene early and avoid development of chronic headache is demonstrated.

Medication-Induced Headache: Overview and Systematic Review of Therapeutic Approaches

MIH is an underrecognized and difficult condition affecting headache-prone patients and it appears that complete withdrawal of the medications being overused is required for favorable long-term results.