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Update on medication-overuse headache

Milena De Felice1, Michael H Ossipov, Frank Porreca

  • 1Department of Pharmacology, College of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ 85724-5050, USA. defelice@email.arizona.edu

Current Pain and Headache Reports
|November 9, 2010
PubMed

Insights

Medication-overuse headache (MOH) arises from using pain relievers too often. Drug overuse can cause lasting changes in the nervous system, increasing headache frequency and intensity.

Area of Science:

  • Neurology
  • Neuroscience
  • Pharmacology

Background:

  • Medication-overuse headache (MOH) is a common complication in migraine patients using acute antimigraine medications frequently.
  • MOH is characterized by increased headache frequency, intensity, and heightened sensitivity to migraine triggers.
  • The precise mechanisms driving MOH development remain incompletely understood.

Purpose of the Study:

  • To explore the neurobiological mechanisms underlying the development of medication-overuse headache.
  • To investigate the role of neuronal plasticity and altered central sensitization in MOH pathogenesis.

Main Methods:

  • Review of preclinical studies examining the effects of opiates and triptans on neuronal pathways involved in pain processing.
  • Analysis of neuroadaptive changes in the trigeminal system and descending modulatory pathways following drug exposure.

Main Results:

  • Preclinical evidence suggests that chronic exposure to antimigraine drugs like opiates and triptans induces persistent, pronociceptive neuroadaptive changes in the trigeminal ganglia.
  • These drug-induced changes can lead to enhanced descending facilitatory influences, amplifying pain signals and contributing to hypersensitivity.
  • Impaired diffuse noxious inhibitory control may also play a role in the development of MOH.

Conclusions:

  • Persistent, pronociceptive adaptations in nociceptors and descending modulatory pathways are hypothesized to be key contributors to medication-overuse headache.
  • Understanding these neurobiological mechanisms may offer novel therapeutic targets for preventing or treating MOH.

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