Medication overuse headache

Last updated
Medication overuse headache
Other namesRebound headache
Specialty Neurology

A medication overuse headache (MOH), also known as a rebound headache, usually occurs when painkillers are taken frequently to relieve headaches. [1] These cases are often referred to as painkiller headaches. [2] Rebound headaches frequently occur daily, can be very painful and are a common cause of chronic daily headache. They typically occur in patients with an underlying headache disorder such as migraine or tension-type headache that "transforms" over time from an episodic condition to chronic daily headache due to excessive intake of acute headache relief medications. MOH is a serious, disabling and well-characterized disorder, which represents a worldwide problem and is now considered the third-most prevalent type of headache. The proportion of patients in the population with Chronic Daily Headache (CDH) who overuse acute medications ranges from 18% to 33%. The prevalence of medication overuse headache (MOH) varies depending on the population studied and diagnostic criteria used. However, it is estimated that MOH affects approximately 1-2% of the general population, but its relative frequency is much higher in secondary and tertiary care. [3]

Contents

Classification

Medication overuse headache is a recognized ICHD (International Classification of Headache Disorders) classification. [4] Over the years different sets of diagnostic criteria have been proposed and revised by the major experts of headache disorders. The term MOH first appeared in the ICHD 2nd edition in 2004. It was defined as a secondary headache, with the aim of emphasising excessive drug intake as the basis of this form of headache. The two subsequent revisions of the diagnostic criteria for MOH (2005 and 2006) refined and extended the definition of the condition on the basis of both its chronicity (headache on more than 15 days/month for more than three months) and drug classes, thereby identifying the main types of MOH. In the case of ergotamine, triptans, opioids and combination medications in particular, intake on > 10 days/month for > 3 months is required, whereas simple analgesics are considered overused when they are taken on > 15 days/month for >3 months. [5]

Causes

MOH is known to occur with frequent use of many different medications, including most commonly: triptans, [6] ergotamines, [7] simple and combination analgesics, [8] [9] and opioids. [10] Dietary and medicinal caffeine consumption appears to be a modest risk factor for chronic daily headache onset, regardless of headache type. [11] [12]

MOH is very rare in patients without a history of recurrent headaches, and it rarely develops in patients who take analgesics for non-headache pain, like arthritis or irritable bowel syndrome. Furthermore, MOH is more probable when a family history of MOH is present, thus indicating a genetic susceptibility. It is thought that rebound headaches are caused by a neuronal re-adjustment process. Analgesic intake raises the pain threshold. Thus, lacking pain stimuli for longer times, the brain re-calibrates to experience normal stimuli as pain. [13]

The time it takes for someone to develop medication overuse headaches (MOH) after taking medication too often depends on the type of medication they are using. If someone is taking triptans (such as Sumatriptan etc), it may take about 1.7 years for them to develop MOH. If they are taking ergots (such as Ergotamine etc) , it may take about 2.7 years, and if they are taking analgesics (such as Naproxen etc), it may take about 4.8 years. So, the delay between taking medication too often and developing MOH varies based on the type of medication being used. [14]

The underlying mechanisms that lead to the development of the condition are still widely unknown and clarification of their role is hampered by a lack of experimental research or suitable animal models. Various pathophysiological abnormalities have been reported and they seem to have an important role in initiating and maintaining chronic headache (genetic disposition, receptor and enzyme physiology and regulation, psychological and behavioural factors, physical dependencies, recent functional imaging results).[ citation needed ]

In some cases, individuals may be genetically predisposed to developing medication overuse headache. A PET study in patients with chronic analgesic overuse showed decreased activity in the orbitofrontal cortex of the brain, which is also seen in substance abuse. This suggests that there may be an underlying neurological susceptibility to addiction in some individuals. However, more research is needed to fully understand the complex interplay of factors that contribute to the development of MOH. [14] [15]

Headache treatment

Opioids and butalbital are sometimes inappropriately used as treatment for migraine and headache and should be avoided in favor of more effective, migraine-specific treatments. [16] [17] Opioid and butalbital use can worsen headaches and cause MOH. [16] When a patient fails to respond to other treatment or migraine specific treatment is unavailable, then opioids may be used. [17]

Regular use of over-the-counter drugs (OTC) such as paracetamol and NSAIDs can also be a cause of MOH. [18] OTC medication for headache should be limited to use for not more than two days weekly, [18] and it is recommended to seek medical counsel when any pain lasts more than a few days. Concurrent with MOH, overuse of acetaminophen (known as paracetamol in some countries) for treating headaches risks causing liver damage and NSAID overuse can cause gastrointestinal bleeding. [18]

Prevention

In general, any patient who has frequent headaches or migraine attacks should be considered as a potential candidate for preventive medications instead of being encouraged to take more and more painkillers or other rebound-causing medications. Preventive medications are taken on a daily basis. Some patients may require preventive medications for many years; others may require them for only a relatively short period of time such as six months. Effective preventive medications have been found to come from many classes of medications including neuronal stabilizing agents (aka anticonvulsants), antidepressants, antihypertensives, and antihistamines. Some effective preventive medications include Elavil (amitriptyline), Depakote (valproate), Topamax (topiramate), and Inderal (propranolol).[ medical citation needed ]

Treatment

MOH is common and can be treated. The overused medications must be stopped for the patient's headache to resolve, though there is limited evidence to suggest this can be done without using other preventive measures. [9] Clinical data shows that the treatment of election is abrupt drugs withdrawal, followed by starting prophylactic therapy. However, the discontinuation of overused drugs may lead to the initial worsening of headaches, nausea, vomiting, sleep disturbance, anxiety, and restlessness. [9] These symptoms greatly depend on the previously overused drugs and typically last from two to ten days. They are relieved by the further intake of the overused medication, which might reinforce the continuation of overuse and noncompliance toward discontinuation. Where physical dependence or a rebound effect such as rebound headache is possible, gradual reduction of medication may be necessary. [19] It is important that the patient's physician be consulted before abruptly discontinuing certain medications as such a course of action has the potential to induce medically significant physical withdrawal symptoms. Abruptly discontinuing butalbital, for example, can actually induce seizures in some patients, although simple over the counter analgesics can safely be stopped by the patient without medical supervision. A long-acting analgesic/anti-inflammatory, such as naproxen (500 mg twice a day), can be used to ease headache during the withdrawal period. [20] [21] Two months after the completion of a medication withdrawal, patients with MOH typically notice a marked reduction in headache frequency and intensity. [22]

Drug withdrawal is performed very differently within and across countries. Most physicians prefer inpatients programmes, however effective drug withdrawal may also be achieved in an outpatient setting in uncomplicated MOH patients (i.e. subjects without important co-morbidities, not overusing opioids or ergotaminics and who are at their first detoxification attempt). In the absence of evidence-based indications, in MOH patients the choice of preventive agent should be based on the primary headache type (migraine or TTH), on the drug side-effect profile, on the presence of co-morbid and co-existent conditions, on patient's preferences, and on previous therapeutic experiences.[ citation needed ]

Following an initial improvement of headache with the return to an episodic pattern, a relevant proportion (up to 45%) of patients relapse, reverting to the overuse of symptomatic drugs.[ citation needed ]

Predictors of the relapse, and that could influence treatment strategies, are considered the type of primary headache, from which MOH has evolved, and the type of drug abused (analgesics, and mostly combination of analgesics, but also drugs containing barbiturates or tranquillisers cause significantly higher relapse rates), while gender, age, duration of disease and previous intake of preventative treatment do not seem to predict relapse rate.[ citation needed ]

MOH is clearly a cause of disability and, if not adequately treated, it represents a condition of risk of possible co-morbidities associated to the excessive intake of drugs that are not devoid of side-effect. MOH can be treated through withdrawal of the overused drug(s) and by means of specific approaches that focus on the development of a close doctor-patient relationship in the post-withdrawal period.[ citation needed ]

History

Rebound headache was first described by Dr. Lee Kudrow in 1982. [23]

See also

Related Research Articles

<span class="mw-page-title-main">Migraine</span> Disorder resulting in recurrent moderate-severe headaches

Migraine is a genetically influenced complex neurological disorder characterized by episodes of moderate-to-severe headache, most often unilateral and generally associated with nausea and light and sound sensitivity. Other characterizing symptoms may include nausea, vomiting, cognitive dysfunction, allodynia, and dizziness. Exacerbation of headache symptoms during physical activity is another distinguishing feature. Up to one-third of migraine sufferers experience aura: a premonitory period of sensory disturbance widely accepted to be caused by cortical spreading depression at the onset of a migraine attack. Although primarily considered to be a headache disorder, migraine is highly heterogenous in its clinical presentation and is better thought of as a spectrum disease rather than a distinct clinical entity. Disease burden can range from episodic discrete attacks, consisting of as little as several lifetime attacks, to chronic disease.

<span class="mw-page-title-main">Headache</span> Pain in the head, neck, or face

Headache, also known as cephalalgia, is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches.

<span class="mw-page-title-main">Cluster headache</span> Neurological disorder

Cluster headache (CH) is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye(s). There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected side. These symptoms typically last 15 minutes to 3 hours. Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year.

<span class="mw-page-title-main">Tension headache</span> Medical condition

Tension headache, stress headache, or tension-type headache (TTH), is the most common type of primary headache. The pain usually radiates from the lower back of the head, the neck, eyes or other muscle groups in the body typically affecting both sides of the head. Tension-type headaches account for nearly 90% of all headaches.

<span class="mw-page-title-main">Visual snow syndrome</span> Visual impairment

Visual snow syndrome (VSS) is a form of visual hallucination that is characterized by the perception of small, flickering dots throughout the visual field. It is present in all conditions of illumination. The dots remain individual and do not clump together or change in size. Visual snow exists in two forms: the pulse type and the broadband type.

<span class="mw-page-title-main">Butalbital</span> Barbiturate drug used for headaches

Butalbital is a barbiturate with an intermediate duration of action. Butalbital is often combined with other medications, such as paracetamol (acetaminophen) or aspirin, for the treatment of pain and headache. The various formulations combined with codeine are FDA-approved for the treatment of tension headaches. Butalbital has the same chemical formula as talbutal but a different structure—one that presents as 5-allyl-5-isobutylbarbituric acid.

<span class="mw-page-title-main">Methysergide</span> Chemical compound

Methysergide, sold under the brand names Deseril and Sansert, is a monoaminergic medication of the ergoline and lysergamide groups which is used in the prophylaxis and treatment of migraine and cluster headaches. It has been withdrawn from the market in the United States and Canada due to adverse effects. It is taken by mouth.

Hemicrania continua (HC) is a persistent unilateral headache that responds to indomethacin. It is usually unremitting, but rare cases of remission have been documented. Hemicrania continua is considered a primary headache disorder, meaning that another condition does not cause it.

<span class="mw-page-title-main">Antimigraine drug</span> Medication intended to reduce the effects or intensity of migraine headache

Antimigraine drugs are medications intended to reduce the effects or intensity of migraine headache. They include drugs for the treatment of acute migraine symptoms as well as drugs for the prevention of migraine attacks.

Mixed tension migraines are also known as mixed migraines or mixed headaches. They combine characteristics of tension headaches and migraines.

<span class="mw-page-title-main">Orthostatic headache</span> Medical condition

Orthostatic headache is a medical condition in which a person develops a headache while vertical and the headache is relieved when horizontal. Previously it was often misdiagnosed as different primary headache disorders such as migraine or tension headaches. Increasing awareness of the symptom and its causes has prevented delayed or missed diagnosis.

New daily persistent headache (NDPH) is a primary headache syndrome which can mimic chronic migraine and chronic tension-type headache. The headache is daily and unremitting from very soon after onset, usually in a person who does not have a history of a primary headache disorder. The pain can be intermittent, but lasts more than 3 months. Headache onset is abrupt and people often remember the date, circumstance and, occasionally, the time of headache onset. One retrospective study stated that over 80% of patients could state the exact date their headache began.

The International Classification of Headache Disorders (ICHD) is a detailed hierarchical classification of all headache-related disorders published by the International Headache Society. It is considered the official classification of headaches by the World Health Organization, and, in 1992, was incorporated into the 10th edition of their International Classification of Diseases (ICD-10). Each class of headache contains explicit diagnostic criteria—meaning that the criteria include quantities rather than vague terms like several or usually—that are based on clinical and laboratory observations.

Cephalalgiaphobia is fear of headaches or getting a headache. Cephalalgia is a Latin-based term for a headache, cephalic meaning head, and algia meaning pain. Harvey Featherstone introduced this phobia in the mid-1980s as a fear of having headache or migraine pain during a pain-free period. Individuals with this phobia often have a history of frequent migraines. Additionally, those with cephalalgiaphobia tend to overuse analgesic medication as a result of their fear. To avoid a future headache or migraine, the individual will preemptively intake analgesic medication to improve their headache. Doctors often do not prescribe pain medications but rather psychiatric medications as a treatment for the phobia. Non-pharmacological treatments using acupuncture therapy have been shown to help reduce the fear of headache pain.

The classification of all headaches, including migraines, is organized by the International Headache Society, and published in the International Classification of Headache Disorders (ICHD). The current version, the ICHD-3 beta, was published in 2013.

Preventive treatment of migraine can be an important component of migraine management. Such treatments can take many forms, including everything from surgery, taking certain drugs or nutritional supplements, to lifestyle alterations such as increased exercise and avoidance of migraine triggers.

Occipital nerve stimulation (ONS), also called peripheral nerve stimulation (PNS) of the occipital nerves, is used to treat chronic migraine patients who have failed to respond to pharmaceutical treatments.

Migraine treatment may be either prophylactic (preventive) or abortive (rescue) or acute. Prevention is better than cure, so the ideal treatment goal is to prevent migraine attacks. Because migraine is an exceedingly complex condition, there are various preventive treatments which have their effect by disrupting different links in the chain of events that occur during a migraine attack. As rescue treatments also target and disrupt different processes occurring during migraine, these are summarized, with their relative merits and demerits.

<span class="mw-page-title-main">Recurrent painful ophthalmoplegic neuropathy</span> Medical condition

Recurrent painful ophthalmoplegic neuropathy (RPON), previously known as ophthalmoplegic migraine (OM), is a rare neurological disorder that is characterized by repeated headache attacks and reversible ipsilateral paresis of one or more ocular cranial nerves (CN). Oculomotor nerve (CNIII) is by far the most common cranial nerve involves in RPON, while abducens nerve (CNVI) and trochlear nerve (CNIV) involvements are also reported. Globally, RPON was estimated to have an annual incidence rate of 0.7 per million as of 1990, no further epidemiological studies have been conducted. It occurs more often in children and females.

<span class="mw-page-title-main">Christopher J. Boes</span> American neurologist and historian

Christopher J. Boes is an American neurologist and historian of medicine. He holds the titles of professor of neurology, professor of history of medicine, director of the W. Bruce Fye Center for the History of Medicine, at the Mayo Clinic, Rochester, Minnesota, and since 2022 is the Mayo Clinic Designated Institutional Official (DIO). His research focuses on the management of headache, including migraine and trigeminal autonomic cephalalgias. His work in the field of history of medicine includes research on Sir William Gowers, Sir William Osler, Bayard Taylor Horton, Mary Broadfoot Walker, Betty Clements and Harry Lee Parker.

References

  1. ↑ Garza, Ivan; Robertson, Carrie E.; Smith, Jonathan H.; Whealy, Mark E. (2022). "102. Headache and other craniofacial pain". In Jankovic, Joseph; Mazziotta, John C.; Pomeroy, Scott L. (eds.). Bradley and Daroff's Neurology in Clinical Practice. Vol. II. Neurological disorders and their management (8th ed.). Edinburgh: Elsevier. p. 1756. ISBN   978-0-323-64261-3.
  2. ↑ "Medically unexplained symptoms". nhs.uk. 19 October 2017. Retrieved 29 March 2021.
  3. ↑ Colás, R.; Muñoz, P.; Temprano, R.; Gómez, C.; Pascual, J. (2004-04-27). "Chronic daily headache with analgesic overuse: Epidemiology and impact on quality of life". Neurology. 62 (8): 1338–1342. doi:10.1212/01.WNL.0000120545.45443.93. ISSN   0028-3878. PMID   15111671. S2CID   27740384.
  4. ↑ "The International Headache Classification". ihs-classification.org. International Headache Society. Archived from the original on 4 March 2016. Retrieved 28 June 2014.
  5. ↑ Ashina, Sait; Terwindt, Gisela M.; Steiner, Timothy J.; Lee, Mi Ji; Porreca, Frank; Tassorelli, Cristina; Schwedt, Todd J.; Jensen, Rigmor H.; Diener, Hans-Christoph; Lipton, Richard B. (2023-02-02). "Medication overuse headache". Nature Reviews Disease Primers. 9 (1): 1–20. doi:10.1038/s41572-022-00415-0. ISSN   2056-676X. PMID   36732518. S2CID   43144437.
  6. ↑ "The International Classification of Headache Disorders". ihs-classification.org. The International Headache Society. Retrieved 28 June 2014.
  7. ↑ "The International Classification of Headache Disorders". ihs-classification.org. The International Headache Society. Archived from the original on 18 November 2012. Retrieved 28 June 2014.
  8. ↑ "The International Classification of Headache Disorders". ihs-classification.org. The International Headache Society. Retrieved 28 June 2014.
  9. 1 2 3 Chiang, Chia-Chun; Schwedt, Todd J; Wang, Shuu-Jiun; Dodick, David W (2016). "Treatment of medication-overuse headache: A systematic review". Cephalalgia. 36 (4): 371–386. doi:10.1177/0333102415593088. ISSN   0333-1024. PMID   26122645. S2CID   36144020.
  10. ↑ "The International Classification of Headache Disorders". ihs-classification.org. The International Headache Society. Retrieved 28 June 2014.
  11. ↑ Scher, Ann I.; Stewart, Walter F.; Lipton, Richard B. (2004). "Caffeine as a risk factor for chronic daily headache: A population-based study". Neurology. 63 (11): 2022–2027. doi:10.1212/01.WNL.0000145760.37852.ED. PMID   15596744. S2CID   25344474.
  12. ↑ Bulletin, Drug Therapeutics (2010). "Management of medication overuse headache". Drug and Therapeutics Bulletin. 340: c1305. doi:10.1136/bmj.c1305. PMID   20427444. S2CID   220110431 . Retrieved 11 April 2018.
  13. ↑ Saxhaug Kristoffersen, Esper; Lundqvist, Christofer (2014). "Medication-overuse headache: a review". Journal of Pain Research. 7: 367–378. doi: 10.2147/JPR.S46071 . PMC   4079825 . PMID   25061336.
  14. 1 2 "Medication Overuse Headache: What are the Causes, Symptoms, Diagnosis, Treatment, and Prevention" . Retrieved 2023-04-27.
  15. ↑ Fumal, Arnaud; Laureys, Steven; Di Clemente, Laura; Boly, Mélanie; Bohotin, Valentin; Vandenheede, Michel; Coppola, Gianluca; Salmon, Eric; Kupers, Ron; Schoenen, Jean (2005-12-05). "Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine". Brain. 129 (2): 543–550. doi: 10.1093/brain/awh691 . ISSN   1460-2156. PMID   16330505.
  16. 1 2 Consumer Reports Health Best Buy Drugs (21 August 2012), "Treating Migraine Headaches: Some Drugs should rarely be used" (PDF), Drugs for Migraine Headaches (AAN), Yonkers, New York: Consumer Reports, retrieved 28 October 2013
  17. 1 2 American Academy of Neurology (February 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation , American Academy of Neurology, retrieved August 1, 2013, which cites
  18. 1 2 3 American Headache Society (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation , American Headache Society, archived from the original on 6 December 2013, retrieved 10 December 2013, which cites
  19. ↑ de Filippis S, Salvatori E, Farinelli I, Coloprisco G, Martelletti P (2007). "Chronic daily headache and medication overuse headache: clinical read-outs and rehabilitation procedures". Clin Ter. 158 (4): 343–7. PMID   17953286.
  20. ↑ Silberstein SD, McCrory DC (2001). "Butalbital in the treatment of headache: history, pharmacology, and efficacy". Headache. 41 (10): 953–67. doi:10.1046/j.1526-4610.2001.01189.x. PMID   11903523. S2CID   27684961.
  21. ↑ Loder E, Biondi D (September 2003). "Oral phenobarbital loading: a safe and effective method of withdrawing patients with headache from butalbital compounds". Headache. 43 (8): 904–9. doi:10.1046/j.1526-4610.2003.03171.x. PMID   12940814. S2CID   36000736.
  22. ↑ Zeeberg P, Olesen J, Jensen R (June 2006). "Probable medication-overuse headache: the effect of a 2-month drug-free period". Neurology. 66 (12): 1894–8. doi:10.1212/01.wnl.0000217914.30994.bd. PMID   16707727. S2CID   23088630.
  23. ↑ Kudrow L (1982). "Paradoxical effects of frequent analgesic use". Adv Neurol. 33: 335–41. PMID   7055014.

Bibliography

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.