Abstract
Medication overuse headache (MOH, formerly known as drug-induced headache) is a well known disorder following the frequent use of analgesics or any other antiheadache drug including serotonin 5-HT1B/D agonists (triptans).
Recent studies suggest clinical features of MOH depend on the substance class that has been overused. The delay between the frequent intake of any antiheadache drug and daily headache is shortest for triptans (mean 1.7 years), longer for ergot alkaloids (mean 2.7 years) and longest for analgesics (mean 4.9 years).
Treatment includes withdrawal followed by structured acute therapy and initiation of specific prophylactic treatment for the underlying primary headache. The relapse rate within 6 months after successful withdrawal is about 30% and increases steadily up to 50% after 5 years.
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References
Peters GA, Horton BT. Headache: with special reference to exessive use of ergotamine preparations and withdrawl effects. Mayo Clin Proc 1951; 26: 214–26
Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988; 8: 1–96
Diener HC, Wilkinson M, editors. Drug-induced headache. New York: Springer Verlag, 1988
Kaube H, May A, Pfaffenrath V, et al. Sumatriptan misuse in daily chronic headache. BMJ 1994; 308: 1573–4
Limmroth V, Kazarawa S, Fritsche G, et al. Headache after frequent use of serotonin agonists zolmitriptan and naratriptan. Lancet 1999; 353: 378
Castillo J, Munoz P, Guitera V, et al. Epidemiology of chronic daily headache in the general population. Headache 1999; 39: 190–6
Wang SJ, Fuh JL, Lu SR, et al. Chronic daily headache in Chinese elderly: prevalence, risk factors, and biannual follow-up. Neurology 2000; 54: 314–9
Robinson RG. Pain relief for headaches. Is self-medication a problem? Can Fam Physician 1993 Apr; 39: 867–8
Granella F, Farina S, Malferrari G, et al. Drug abuse in chronic headache: a clinico-epidemiologic study. Cephalalgia 1987; 7: 15–9
Micieli G, Manzoni GC, Granella F, et al. Clinical and epidemiological observations on drug abuse in headache patients. In: Diener HC, {Wilkinson M}, editors. MOH. Berlin: Springer, 1988: 20–8
Rapoport A, Stang P, Gutterman DL, et al. Analgesic rebound headache in clinical practice: data from a physician survey. Headache 1996; 36: 14–9
Gutzwiller F, Zemp E. Der Analgetikakonsum in der Bevölkerung und socioökonomische Aspekte des Analgetikaabusus. In: Mihatsch MJ, editor. Stutgart; Das Analgetikasyndrom Thieme, 1986: 197
Schwarz A, Farber U, Glaeske G. Daten zu Analgetikakonsum und Analgetikanephropathie in der Bundesrepublik. Offentl Gesundheitswes 1985; 47: 298
Gaist D. Use and overuse of sumatriptan. Pharmacoepidemiological studies based on prescription register and interview data. Cephalalgia 1999; 19: 735–61
Evers S, Bauer B, Suhr B, et al. The epidemiology of sumatriptan abuse. In: Olesen J, Tfelt-Hansen P, editors. Headache treatment: trial methodology and new drugs. Philadelphia: Lippincott-Raven, 1997: 149–52
Diener HC, Dahlöf CGH. Headache associated with chronic use of substances. Olesen J, Tfelt-Hansen P, Welch KMA, editors. The headaches. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins, 1999: 871–8
Catarci T, Fiacco F, Argentino C, et al. Ergotamine-induced headache can be sustained by sumatriptan daily intake. Cephalalgia 1994; 14: 374–5
Gaist D, Hallas J, Sindrup SH, et al. Is overuse of sumatriptan a problem? A population-based study. Eur J Clin Pharmacol 1996; 3: 161–5
Gaist D, Tsiropoulus I, Sindrup SH, et al. Inappropriate use of sumatriptan: population based register and interview study. BMJ 1998; 316: 1352–3
Pini LA, Trenti T. Case report: does chronic use of sumatriptan induce dependence? Headache 1994; 34: 600–1
Katsarava Z, Fritsche G, Diener HC, et al. MOH (DIH) following the use of different triptans. Cephalalgia 2000; 20: 293
Bahra A, Walsh M, Menon S, et al. Does chronic daily headache arise de novo in association with regular analgesic use? Cephalalgia 2000; 20: 294
Lance F, Parkes C, Wilkinso M. Does analgesic abuse cause headache de novo? Headache 1988; 38: 61–2
Diamond S. Caffeine as an analgesic adjuvant in the treatment of headache. Headache 1999; 44: 4778–9
Migliardi JR, Armellino JJ, Friedmann M, et al. Caffeine as an analgesic adjuvant in tension headache. Clin Pharmacol Ther 1994; 56: 576–86
Silverman K, Evans SM, Strain EC, et al. Withdrawal syndrome after the double-blind cessation of caffeine consumption. N Engl J Med 1992; 327: 1109–14
van Dusseldorp M, Katan MB. Headache caused by caffeine withdrawal among moderate coffee drinkers switched from ordinary to decaffeinated coffee: a 12 week double blind trial. BMJ 1990; 300: 1558–9
Feinstein AR, Heinemann LA, Dalessio D, et al. Do caffein-econtaining analgesics promote dependence? A review and evaluation. Clin Pharmacol Ther 2000; 68: 457–67
Fisher MA, Glass S. Butorphanol (Stadol): a study in problems of current drug information and control. Neurology 1997; 48: 1156–60
Ziegler DK. Opiate und opioid use in patients with refractory headache. Cephalalgia 1994; 14: 5–10
John GW, Pauwels PJ, Perez M, et al. F 11356, a novel 5-hydroxytryptamine (5-HT) derivative with potent, selective, and unique high intrinsic activity at 5-HT1B/1D receptors in models relevant to migraine. J Pharmacol Exp Ther 1999; 290: 83–95
Dichgans J, Diener HC, Gerber WD, et al. Analgetika-induzierter Dauerkopfschmerz. Dtsch Med Wochenschr 1984; 109: 369–73
Gobel H, Stolze H, Heinze A, et al. Easy therapeutical management of sumatriptan-induced daily headache. Neurology 1996; 47: 297–8
Katsarava Z, Fritsche G, Mueßig M, et al. Clinical features of withdrawal headache following overuse of triptans in comparison to other anti-headache drugs. Neurology. In press
Haag G, Baar H, Grotemeyer KH, et al. Prophylaxe und Therapie des medikamenteninduzierten Dauerkopfschmerzes. Schmerz 1999; 13: 52–7
Mathew NT, Ali S. Valproate in the treatment of persistent chronic daily headache. An open labelled study. Headache 1991; 31: 71–4
Krymchantowski AV, Barbosa JS. Prednisone as initial treatment of analgesic-induced daily headache. Cephalalgia 2000; 20: 107–13
Diener HC, Haab J, Peters C, et al. Subcutaneous sumatriptan in the treatment of headache during withdrawal from MOH. Headache 1990; 31: 205–9
Mathew NT. Amelioration of ergotamine withdrawal with naproxen. Headache 1987; 27: 130–3
Mathew NT, Kurman R, Perez F. Drug induced refractory headache-clinical features and management. Headache 1990; 30: 634–8
Linton-Dahlof P, Linde M, Dahlof C. Withdrawal therapy improves chronic daily headache associated with long-term misuse of headache medication: a retrospective study. Cephalalgia 2000; 20: 658–62
Baumgartner C, Wessely P, Bingöl C, et al. Longterm prognosis of analgesic withdrawal in patients with drug-induced headaches. Headache 1989; 29: 510–4
Diener HC, Dichgans J, Scholz E, et al. Analgesic-induced chronic headache: long-term results of withdrawal therapy. J Neurol 1989; 236: 9–14
Schnider P, Aull S, Baumgartner C, et al. Long-term outcome of patients with headache and drug abuse after inpatient withdrawal: five year follow-up. Cephalalgia 1996; 16: 481–5
Fritsche G, Eberl A, Katsarava Z, et al. Drug-induced headache: long-term follow-up of withdrawal therapy and persistence of drug misuse. Eur Neurol 2001; 45: 229–35
Tfelt-Hansen P, Krabbe AA. Ergotamine abuse: do patients benefit from withdrawal? Cephalalgia 1981; 1: 29–31
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Katsarava, Z., Diener, HC. & Limmroth, V. Medication Overuse Headache. Drug-Safety 24, 921–927 (2001). https://doi.org/10.2165/00002018-200124120-00005
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DOI: https://doi.org/10.2165/00002018-200124120-00005