Medication Overuse in Children and Adolescents
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Medication overuse is not uncommon among children and adolescents with primary headache disorders. Medication overuse in adults is associated with increased headache frequency and reduced effectiveness of acute and preventive medications. These issues probably exist in children. While withdrawal of overused medications is generally recommended, it may not result in improved headache frequency in all patients. This review summarizes what is known about predicting the response to medication withdrawal. Strategies for managing children and adolescents with medication overuse are also offered.
KeywordsMedication overuse headache Rebound headache Withdrawal headache Pediatric headache
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Conflict of Interest
Dr. Amy A. Gelfand receives grant support from NIH/NINDS (K12NS001692) and the UCSF Center for Translational Science Institute. She has received honoraria from Journal Watch Neurology and personal compensation for legal consulting.
Dr. Peter J. Goadsby is on the boards of Allergan, Colucid, MAP pharmaceuticals, Merck, Sharpe and Dohme, eNeura, Autonomic Technologies Inc, Boston Scientific, Eli-Lilly, Medtronic, Linde gases, Electrocore, Arteaus, AlderBio and BristolMyerSquibb. He has consulted for Pfizer, Nevrocorp , Zogenix, Impax, Zosano and Dr. Reddy, and has been compensated for expert legal testimony. He has grant support from MAP, MSD, Allergan, and Amgen. He has received honoraria for speaking from Pfizer and Allergan, and payment for editorial work from Journal Watch Neurology and for developing educational materials for the American Headache Society.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as • Of importance •• Of outstanding importance
- 8.••The International Classificatio of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33:629-808. Released in June 2013, this is now the most current classification scheme for headache disorders.Google Scholar
- 9.••Hershey AD, Burdine D, Kabbouche MA, Powers SW. Genomic expression patterns in medication overuse headaches. Cephalalgia: Int J Headache. 2011;31:161–71. The genomic expression pattern of those pediatric patients who improved after medication withdrawal and those who did not are compared.CrossRefGoogle Scholar
- 10.••Riederer F, Gantenbein AR, Marti M, Luechinger R, Kollias S, Sandor PS. Decrease of Gray Matter Volume in the Midbrain is Associated with Treatment Response in Medication-Overuse Headache: Possible Influence of Orbitofrontal Cortex. J Neurosci: Off J Soc Neurosci. 2013;33:15343–9. This article reports on changes in grey matter volume in certain areas of the brain following withdrawal of overused medication, and how orbitofrontal cortex structure may predict response.CrossRefGoogle Scholar
- 15.Gelfand AA, Reider AC, Goadsby PJ. Outcomes of Greater Occipital Nerve Injections in Pediatric Patients with Chronic Primary Headache Disorders. Pediatr Neurol Press.Google Scholar
- 21.••Gomez-Beldarrain M, Carrasco M, Bilbao A, Garcia-Monco JC. Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse. J Headache Pain. 2011;12:459–66. Describes how orbitofrontal dysfunction can be used to predict which chronic migraine pateints with medication overuse will improve after medication withdrawal.PubMedCentralPubMedCrossRefGoogle Scholar
- 22.•Cady R, Nett R, Dexter K, Freitag F, Beach ME, Manley HR. Treatment of Chronic Migraine: A 3-Month Comparator Study of Naproxen Sodium vs SumaRT/Nap. Headache 2013. Describes the use of nparoxen for treatment of chronic migraine. Google Scholar
- 23.Lewis D, Middlebrook M, Deline C. Naproxen sodium for chemoprophylaxis of adolescent migraine. Ann Neurol. 1994;36:542.Google Scholar
- 32.•Cady R, O'Carroll P, Dexter K, Freitag F, Shade CL. SumaRT/Nap vs Naproxen Sodium in Treatment and Disease Modification of Migraine: A Pilot Study. Headache 2013. Desribes the use of naproxen for disease modification in migraine. Google Scholar