Management of medication overuse headacheBMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c1305 (Published 28 April 2010) Cite this as: BMJ 2010;340:c1305
- Drug and Therapeutics Bulletin
- 1Drug and Therapeutics Bulletin Editorial Office, London WC1H 9JR
Headache is one of the most frequent reasons for medical consultation in both general practice and specialist neurology clinics.1 Prescribed and over-the-counter medications are taken to alleviate headaches, but may be used incorrectly.2 In particular, use of some drugs both frequently and regularly can have a paradoxical effect, causing headaches rather than relieving them, and leading to medication overuse headache (MOH).3 Such overuse is a common cause of frequent headache. Here we review MOH and its management.
The International Classification of Headache Disorders, 2nd edition states that for a diagnosis of MOH, all of the following criteria must be present:
headache occurring on 15 or more days per month;
regular overuse for more than 3 months of one or more acute/symptomatic treatment drugs (ergotamine, triptans, opioids or combined analgesic medications [typically simple analgesics plus opioids or caffeine] on 10 or more days per month; or simple analgesics alone or any combination of ergotamine, triptans and analgesic opioids on 15 or more days per month); and
development or marked worsening of headache during medication overuse.4
The preceding headache problem
Headaches may be primary (eg, migraine, tension-type headache, cluster headache) or secondary (eg, associated with trauma, subarachnoid haemorrhage, intracranial neoplasm, infection or the use or withdrawal of substances such as alcohol or drugs).3 5 MOH occurs only in patients with a history of primary headache.6 7 It is most likely to affect patients with migraine and/or tension-type headache,7 8 but can also arise in association with cluster headache, particularly if there is a personal or family history of migraine or regular headache.9
Studies from various countries suggest that the prevalence of MOH is around 1% of adults and 0.5% of adolescents (aged 13–18 years) in the general population;10 around 25–64% in those attending tertiary care headache …
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