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Related Experiment Video

Updated: Sep 9, 2025

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Exploring medication-overuse and medication-overuse headache in cluster headache.

Nunu Lund1, Marie-Louise Kulas Søborg1, Louise Ninett Carlsen1,2

  • 1Danish Headache Center, Department of Neurology, University of Copenhagen, Rigshospitalet - Glostrup, Glostrup, Denmark.

Cephalalgia : an International Journal of Headache
|August 29, 2025
PubMed
Summary
This summary is machine-generated.

Medication-overuse headache (MOH) affects 16% of cluster headache (CH) patients, with overuse of simple analgesics, triptans, and opioids being common. Chronic CH and migraine comorbidities are associated factors, impacting treatment effectiveness.

Keywords:
analgesicsburdenclinical presentationcluster headachemedication-overuse headachetreatment

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Area of Science:

  • Neurology
  • Headache Medicine

Background:

  • Medication-overuse headache (MOH) prevalence and diagnostic criteria in cluster headache (CH) remain unclear.
  • Investigating MOH in CH is crucial for understanding its impact on disease management and patient outcomes.

Purpose of the Study:

  • To determine the prevalence of medication-overuse and probable MOH in a well-characterized CH cohort.
  • To identify factors associated with MOH in CH and assess its clinical impact.
  • To evaluate the suitability of existing MOH diagnostic criteria for CH.

Main Methods:

  • A semi-structured interview was conducted with 433 participants diagnosed with CH according to ICHD-3 criteria.
  • Medication-overuse and probable MOH were assessed using ICHD-3 criteria, with a conservative definition also applied (daily bilateral headache).
  • Associated factors and clinical impact, including treatment effectiveness, were analyzed.

Main Results:

  • 21% of CH patients exhibited medication-overuse, with 16% meeting probable MOH criteria (12% excluding isolated triptan overuse).
  • Overused medications included simple analgesics (52.2%), triptans (37.3%), opioids (29.9%), and combination therapies (20.9%).
  • Chronic CH (OR=11.4) and comorbid migraine (OR=2.35) were associated factors. Probable MOH was linked to longer attack duration and reduced treatment efficacy.

Conclusions:

  • Probable MOH is present in approximately 16% of CH patients, with a lower prevalence (4%) under a conservative definition.
  • Existing MOH criteria may require adaptation for CH, particularly given daily attacks and inter-ictal pain.
  • MOH in CH is associated with reduced effectiveness of acute and preventive treatments, warranting further investigation into its role as an aggravating factor.