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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
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Published on: June 2, 2014

Medication-overuse headache.

Stewart J Tepper1

  • 1Cleveland Clinic, Headache Center, Cleveland, OH, USA. teppers@ccf.org

Continuum (Minneapolis, Minn.)
|August 8, 2012
PubMed
Summary
This summary is machine-generated.

Medication-overuse headache (MOH) is a chronic daily headache caused by frequent use of acute headache medications. Limiting acute medication use to two days per week and initiating preventive treatment are key to managing MOH.

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Area of Science:

  • Neurology
  • Pharmacology
  • Headache Medicine

Background:

  • Medication-overuse headache (MOH) is a chronic daily headache condition resulting from the frequent use of acute medications for headache treatment.
  • MOH is recognized as a form of chronic migraine, impacting patients with 15 or more headache days per month.
  • Understanding the clinical features, pathophysiology, and treatment strategies for MOH is crucial for effective patient management.

Observation:

  • High-frequency use of acute medications, including butalbital, opioids, triptans, and NSAIDs, increases the risk of transforming episodic migraine into chronic migraine.
  • Specific thresholds for monthly acute medication use (e.g., 5 days for butalbital, 8 for opioids, 10 for triptans/combination analgesics, 10-15 for NSAIDs) are associated with this transformation.
  • MOH is associated with structural and functional changes in the brain.

Findings:

  • Acute migraine treatment should be restricted to two or fewer days per week, with avoidance of opioids and butalbital.
  • Effective MOH treatment involves a comprehensive approach: complete cessation of overused acute medications, initiation of preventive therapy, and provision of appropriate acute treatments for severe migraine attacks.
  • Medication withdrawal can be managed through slow outpatient weaning or abrupt discontinuation, potentially requiring hospitalization and bridging medications.

Implications:

  • MOH development is influenced by baseline headache frequency, the class and frequency of acute medication use, and other risk factors.
  • Inadequate treatment of severe migraine with less effective medications can lead to increased dosing and prolonged attacks, ultimately causing chronification.
  • Most MOH patients can be effectively treated with a combination of medication withdrawal, preventive strategies (e.g., onabotulinumtoxinA), and judicious use of acute medications.