Medication overuse headache: awareness, detection and treatment

Area of Science:

• Neurology
• Pain Medicine

Background:

• Episodic migraine significantly impairs daily functioning and social interactions.
• Patients may experience 'interictal burden,' including anxiety about future attacks, leading to acute medication overuse.
• Medication overuse can paradoxically result in medication overuse headaches (MOHs) and chronic migraine, often unrecognized by patients and physicians.

Purpose of the Study:

• To highlight the underrecognized issue of medication overuse in episodic migraine.
• To emphasize the importance of physician-patient communication regarding medication overuse risks.
• To propose effective management strategies for medication overuse headaches.

Main Methods:

• Review of current understanding of episodic migraine and medication overuse.
• Discussion of the pathophysiology and clinical presentation of medication overuse headaches.
• Analysis of treatment approaches including detoxification, preventive medications, and behavioral therapy.

Main Results:

• Medication overuse is a common complication of episodic migraine management.
• Lack of awareness contributes to the progression of medication overuse headaches.
• Preventive treatments, initiated before or during detoxification, alongside reduced acute medication use, show promise.

Conclusions:

• Physician awareness and patient education are critical to prevent and manage medication overuse.
• A comprehensive treatment plan involving detoxification, preventive medications (e.g., sodium valproate, topiramate), and behavioral therapy is optimal for MOHs.
• Long-term management should integrate preventive and acute therapies to improve patient outcomes.