Date: 09 Nov 2010
Update on Medication-overuse Headache
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Medication-overuse headache (MOH) is a syndrome that can develop in migraineurs after overuse of antimigraine drugs, including opiates and triptans especially. MOH manifests as increased frequency and intensity of migraine attacks and enhanced sensitivity to stimuli that elicit migraine episodes. Although the mechanisms underlying MOH remain unknown, it is hypothesized that repeated use of antimigraine drugs could elicit increased headache attacks as a consequence of neuronal plasticity that may increase responsiveness to migraine triggers. Preclinical studies show that exposure to either opiates or triptans can induce pronociceptive neuroadaptive changes in the orofacial division of the trigeminal ganglia that persist even after discontinuation of the drug treatment. Additionally, medications can elicit increased descending facilitatory influences that may amplify evoked inputs from trigeminal afferents leading to behavioral hypersensitivity reminiscent of cutaneous allodynia observed clinically. Importantly, enhanced descending facilitation may manifest as an inhibition of diffuse noxious inhibitory control. Persistent, pronociceptive adaptations in nociceptors as well as within descending modulatory pathways thus may jointly contribute to the development of MOH.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
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•• Supornsilpchai W, le Grand SM, Srikiatkhachorn A: Cortical hyperexcitability and mechanism of medication-overuse headache. Cephalalgia 2010, 30:1101–1109. This article includes observations that MOH might be due to alteration of cortical excitability, which leads to an increased susceptibility of CSD development.PubMedCrossRef
- Update on Medication-overuse Headache
Current Pain and Headache Reports
Volume 15, Issue 1 , pp 79-83
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