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[Gordian knot: medication overuse headache].

Z Katsarava¹, G Fritsche

¹Neurologische Klinik, Universitätsklinikum Essen. Zaza.Katsarava@uni-essen.de

Schmerz (Berlin, Germany)

|August 24, 2004

Summary

Overusing headache medications can cause medication overuse headache (MOH). Treatment involves drug withdrawal and specific therapies, but relapse is common, especially with certain drug combinations.

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Area of Science:

Neurology
Pharmacology

Background:

Medication overuse headache (MOH) arises from the excessive use of acute headache medications.
Clinical presentation of MOH varies based on the overused drug class.

Purpose of the Study:

To describe the clinical features, onset times, treatment, and relapse predictors of medication overuse headache.

Main Methods:

Review of clinical features associated with overuse of analgesics, triptans, and ergots.
Analysis of treatment strategies including withdrawal and prophylactic therapies.
Identification of predictors for relapse after successful withdrawal.

Main Results:

Analgesic overuse leads to chronic tension-type headache; triptan overuse causes daily migraine-like headache or increased frequency.
Onset of daily headache after overuse is fastest with triptans (1.7 years), followed by ergots (2.7 years), and analgesics (4.8 years).
Relapse rate after withdrawal is approximately 30%, with tension-type headache and overuse of analgesics combined with codeine, caffeine, or opioids being significant predictors.

Conclusions:

Medication overuse headache is a distinct entity with varied clinical features depending on the overused drug.
Successful treatment requires drug withdrawal, acute therapy, and prophylaxis for the primary headache disorder.
Predicting and preventing relapse is crucial, particularly in patients with specific headache types and medication overuse patterns.

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