Is Medication Overuse Drug Specific or Not? Data from a Review of Published Literature and from an Original Study on Italian MOH Patients

  • Licia Grazzi
  • Eleonora Grignani
  • Domenico D’Amico
  • Emanuela Sansone
  • Alberto Raggi
Migraine and Beyond (R Cowan, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Migraine and Beyond


Purpose of Review

The aim is twofold. First, to give an insight on the role exerted by different classes of drugs in favouring migraine chronification. Second, to explore the relationship between type and amount of overused medications and history of previous withdrawal treatment and of frequent relapses.

Recent Findings

All drug classes were found to favour migraine chronification. No data are available for the association with relapses into CM-MOH. Our clinical study shows that patients who underwent previous withdrawal treatments were more likely to be overusers of multiple drug classes and overuse higher amounts of symptomatic medications, particularly, indomethacin, eletriptan and tramadol. Frequent relapsers were more likely to be overusers of opioids or ergotamine and caffeine derivates or of multiple classes, particularly acetylsalicylic acid and ergotamine/caffeine derivates.


The joint results our review and clinical study do not seem to support the idea that MOH is drug-specific: rather, it points out that all drug classes may induce migraine chronification. Those drugs which are at higher risk of overuse are among those preferred by the “worst” patients, i.e. those who needed one or more withdrawal treatments for MOH. Our results reinforce the clinical impression that patients with CM and MOH, and particularly the most difficult to treat for their poor response to withdrawal treatments, are characterised by a particular drive towards the consumption of “whatever is likely to be perceived to provide some relief”, despite these drugs that are perceived as “more powerful”, are often indicated as second- or third-line medications.


Chronic migraine Medication-overuse headache Triptans Anti-inflammatory drugs Opioids Withdrawal 


Compliance with Ethical Standards

The protocol was approved by the Besta Institute Ethical Committee (protocol no. 379/2015).

Conflict of Interest

The authors declare that they have no conflict of interest.

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.

Supplementary material

11916_2018_729_MOESM1_ESM.docx (23 kb)
ESM 1 (DOCX 22 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Licia Grazzi
    • 1
  • Eleonora Grignani
    • 2
  • Domenico D’Amico
    • 1
  • Emanuela Sansone
    • 1
  • Alberto Raggi
    • 2
  1. 1.Division of NeuroalgologyFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
  2. 2.Neurology, Public Health and Disability UnitFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly

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