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Medication overuse headache
Sait Ashina1,2, Gisela M Terwindt3, Timothy J Steiner4,5,6
1BIDMC Comprehensive Headache Center, Department of Neurology and Department of Anaesthesia, Critical Care and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA. sashina@bidmc.harvard.edu.
Abstract:
Medication overuse headache (MOH) is a secondary headache disorder attributed to overuse of acute headache medications by a person with an underlying headache disorder, usually migraine or tension-type headache. MOH is common among individuals with 15 or more headache days per month. Although MOH is associated with substantial disability and reductions in quality of life, this condition is often under-recognized. As MOH is both preventable and treatable, it warrants greater attention and awareness. The diagnosis of MOH is based on the history and an unremarkable neurological examination, and is made according to the diagnostic criteria of the International Classification of Headache Disorders third edition (ICHD-3). Pathophysiological mechanisms of MOH include altered descending pain modulation, central sensitization and biobehavioural factors. Treatment of MOH includes the use of headache preventive therapies, but essential to success is eliminating the cause, by reducing the frequency of use of acute headache medication, and perhaps withdrawing the overused medication altogether. Appropriate treatment is usually highly effective, leading to reduced headache burden and acute medication consumption.
Insights
Medication overuse headache (MOH) is a common secondary headache disorder often under-recognized. Early diagnosis and treatment, including reducing acute medication use, can significantly decrease headache burden.
Area of Science:
- Neurology
- Clinical Medicine
Background:
- Medication overuse headache (MOH) is a secondary headache disorder resulting from the excessive use of acute headache medications in individuals with pre-existing headache conditions like migraine or tension-type headache.
- It frequently affects individuals experiencing 15 or more headache days monthly, leading to significant disability and diminished quality of life.
- Despite its prevalence and impact, MOH remains under-recognized, highlighting a need for increased awareness and attention.
Purpose of the Study:
- To underscore the importance of recognizing and addressing medication overuse headache (MOH) as a treatable and preventable condition.
- To provide an overview of the diagnostic criteria and underlying pathophysiological mechanisms of MOH.
- To emphasize effective treatment strategies for MOH, focusing on medication reduction and preventive therapies.
Main Methods:
- Diagnosis relies on patient history and a normal neurological examination, adhering to the International Classification of Headache Disorders third edition (ICHD-3) criteria.
- Pathophysiological insights involve understanding altered pain modulation, central sensitization, and biobehavioral factors.
- Treatment strategies focus on discontinuing the overused acute medications and initiating preventive headache therapies.
Main Results:
- Effective treatment of MOH leads to a substantial reduction in headache frequency and the consumption of acute medications.
- Addressing the root cause—overuse of acute headache drugs—is crucial for successful management.
- Patients typically experience a significant decrease in their overall headache burden following appropriate intervention.
Conclusions:
- Medication overuse headache (MOH) is a prevalent and disabling condition that requires greater clinical recognition.
- Diagnosis based on ICHD-3 criteria and understanding pathophysiological mechanisms guide effective management.
- Treatment, centered on reducing acute medication intake and employing preventive strategies, offers a highly effective means to alleviate symptoms and improve quality of life.
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