Medication overuse headache.
نویسنده
چکیده
PURPOSE OF REVIEW Medication-overuse headache (MOH) is a chronic daily headache in which acute medications used at high frequency cause transformation to headache occurring 15 or more days per month for 4 or more hours per day if left untreated. MOH is a form of US Food and Drug Administration-defined chronic migraine. This review will describe (1) MOH clinical features and diagnosis, (2) pathophysiology and structural and functional MOH brain changes, and (3) prevention and treatment of MOH. RECENT FINDINGS MOH causes structural and functional brain changes. Any butalbital or opioid use increases the risk of transforming episodic into chronic migraine (sometimes referred to as chronification). The American Migraine Prevalence and Prevention Study demonstrated that transformation is most likely to occur with 5 days of butalbital use per month, 8 days of opioid use per month, 10 days of triptan or combination analgesic use per month, and 10 to 15 days of nonsteroidal anti-inflammatory use per month. Acute migraine treatment should be limited to 2 or fewer days per week, and opioids and butalbital should be avoided.Treatment of MOH consists of combining prophylaxis, 100% wean of overused acute medications, and provision of new acute medications, strictly limiting use to 2 or fewer days per week. Wean can be done slowly in an outpatient setting or it can be done abruptly, sometimes requiring hospitalization with medicine bridges. SUMMARY MOH development is linked to baseline frequency of headache days per month, acute medication class ingested, frequency of acute medications ingested, and other risk factors. Using less effective or nonspecific medication for severe migraine results in inadequate treatment response, with redosing and attack prolongation, frequently leading to chronification. Use of any barbiturates or opioids increases the transformation likelihood.Patients with MOH can usually be effectively treated. The first step is 100% wean, followed by establishing preventive medications such as onabotulinumtoxinA or daily prophylaxis and providing acute treatment for severe migraine 2 or fewer days per week. Slow wean or quick termination of rebound medications can be accomplished for most patients on an outpatient basis, but some more difficult problems may need referral for multidisciplinary day hospital or inpatient treatments.
منابع مشابه
Celecoxib or Prednisolone for Treatment of Medication Overuse Headache: A Randomized, Double-Blind Clinical Trial in Migrainous Patients
Background:Treatment of Medication Overuse Headache (MOH) is yet under debate and Celecoxib as a Cyclooxygenase 2 (COX2) -inhibitor has not been tried widely as a pain relief drug for this type of headaches in migrainous patients. Objectives: comparing the efficacy of celecoxib versus prednisolone for withdrawal period of MOH. Materials & Methods: A double-blind, randomized clinical tri...
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From the Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan. Correspondence to: Yen-Yu Chen, MD. Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan. No.135, Nan-Hsiao St., Changhua City, Changhua County 500, Taiwan. E-mail: [email protected] A B Patients with primary headaches, especially migraine, often need symptomatic medications. Prolonged and fr...
متن کاملPreventing and treating medication overuse headache
Medication overuse headache is a secondary headache-a worsening of a pre-existing headache (usually a primary headache) owing to overuse of one or more attack-aborting or pain-relieving medications.
متن کامل[Medication-overuse headache].
Medication-overuse headache affects 1 to 2 percent of the population. Any kind of painkiller, if taken regularly at least 10 days per month can cause medication-overuse headache, and therefore the possibility of this headache has to be raised whenever a patient with a preexistent headache notices a significant increase in headache frequency during a period of frequent painkiller consumption. Me...
متن کاملLower hippocampal subfields volume in relation to anxiety in medication-overuse headache
Background Hippocampus (HIP) was an important limbic structure, and concurrent emotion disorders may occur in medication-overuse headache patients. The aim of this study is to investigate altered HIP and HIP subfields volume in relation with the anxiety in medication-overuse headache patients using a state-of-the-art hippocampal segment method. Results The current study presented that a signifi...
متن کاملSelf-medication of regular headache: a community pharmacy-based survey.
BACKGROUND This observational community pharmacy-based study aimed to investigate headache characteristics and medication use of persons with regular headache presenting for self-medication. METHODS Participants (n = 1205) completed (i) a questionnaire to assess current headache medication and previous physician diagnosis, (ii) the ID Migraine Screener (ID-M), and (iii) the Migraine Disabilit...
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ورودعنوان ژورنال:
- Headache
دوره 57 5 شماره
صفحات -
تاریخ انتشار 2012