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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
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The Evolution of Medication Overuse Headache: History, Pathophysiology and Clinical Update
Christina Sun-Edelstein1, Alan M Rapoport2, Wanakorn Rattanawong3
1Department of Clinical Neurosciences, St Vincent's Hospital, University of Melbourne, Melbourne, Australia. Christina.Sun-Edelstein@svha.org.au.
CNS Drugs
|May 18, 2021
Summary
Medication overuse headache (MOH) is a common disorder. New anti-calcitonin gene-related peptide (CGRP) therapies suggest patients may not need detoxification for successful MOH treatment.
Area of Science:
- Neurology
- Pharmacology
Background:
- Medication overuse headache (MOH) is a prevalent secondary headache disorder with substantial personal and societal impact.
- It arises from frequent medication use for acute headache treatment, potentially suppressing endogenous pain control.
- MOH is a modifiable risk factor in the progression from episodic to chronic migraine.
Purpose of the Study:
- To review the evolution of MOH diagnostic criteria and current understanding of its pathogenesis.
- To discuss ongoing debates in MOH development and treatment strategies.
- To present data on anti-CGRP monoclonal antibodies for MOH and their implications.
Main Methods:
- Literature review of MOH diagnostic criteria and pathogenesis.
- Analysis of treatment strategies, including detoxification and preventive therapies.
- Evaluation of efficacy data for anti-CGRP monoclonal antibodies in MOH patients.
Main Results:
- Chronic migraine treatment may up-regulate the calcitonin gene-related peptide (CGRP) system.
- Anti-CGRP monoclonal antibodies show efficacy in MOH patients.
- These new treatments may obviate the need for formal detoxification in some MOH cases.
Conclusions:
- MOH pathogenesis involves the CGRP system and suppression of endogenous antinociceptive pathways.
- The advent of anti-CGRP therapies is reshaping perspectives on MOH treatment.
- Future MOH management may involve easier diagnosis and improved patient outcomes without mandatory detoxification.
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