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Medication-overuse headache: what is it and how do you treat it?

Publisher: North West Medicines Information Centre

Keywords: Analgesics; Headache; serotonin-1 receptor agonists; analgesics-narcotic; analgesics-anti-inflammatory; ergot compounds

Date published: 26/10/2011 12:16

Review date: 31/10/2013 00:00

Summary
by: Joanne McEntee
  • Medication-overuse headache (MOH) is defined as a headache that is present on 15 or more days of the month and has developed or worsened whilst the patient has been regularly using analgesic or anti-migraine medicines for more than three months. It occurs only in patients with a pre-existing primary headache disorder, usually migraine or tension-type headache.
  • All medicines used for treating headache can cause MOH. This includes simple analgesics (aspirin, paracetamol), opioids, triptans, non-steroidal anti-inflammatory drugs and ergots, alone or in combination with caffeine, barbiturates or benzodiazepines.
  • Abrupt withdrawal of the overused medication is the treatment of choice for most patients, although there are no prospective randomised trials comparing abrupt with gradual withdrawal. Patients can be managed in primary care with abrupt withdrawal, provided sudden cessation of their overused medicine is not contraindicated, they have sufficient support and are well informed about the cause of MOH and prognosis following withdrawal. Those taking opioids, benzodiazepines or barbiturates, and those who are poorly motivated, pregnant or have a significant co-existing medical or psychiatric disorder should be referred to a specialist.
  • Patients are likely to require drug treatment to alleviate withdrawal symptoms. This should include adequate hydration, anti-emetics and, if unable to tolerate withdrawal headache, short-term regular agents of a different class to the overused medication.
  • Relapse may be prevented through education of patients, use of headache diaries, extended close medical supervision, restrictions on the intake of headache medication, primary headache prophylactic drugs and use of behavioural therapies.
QA126.3_MOH_final2011.doc

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