Abstract
Medication overuse headache (MOH) is a common and disabling headache disorder. It has a prevalence of about 1–2 % in the general population. The International Classification of Headache Disorders 3rd edition (beta version) has defined MOH as a chronic headache disorder in which the headache occurs on 15 or more days per month due to regular overuse of medication. These headaches must have been present for more than 3 months. The pathophysiology is complex and not completely known. It involves genetic and behavioural factors. There is evidence that cortical spreading depression, trigeminovascular system and neurotransmitters contribute to the pain pathway of MOH. The treatment of MOH includes patient education, stopping the offending drug(s), rescue therapy for withdrawal symptoms and preventative therapy. Relapse rates for MOH are high at 41 %. MOH can severely impact quality of life, so it is important to identify patients who are at risk of analgesic overuse.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
Westergaard ML, Hansen EH, Glumer C, Olesen J, Jensen RH. Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates: a systematic review. Cephalalgia. Nov 29 2013.
Peters GA, Horton BT. Headache: with special reference to the excessive use of ergotamine preparations and withdrawal effects. Proc Staff Meet Mayo Clin. 1951;26(9):153–61.
Horton BT, Peters GA. Clinical manifestations of excessive use of ergotamine preparations and management of withdrawal effect: report of 52 cases. Headache. 1963;2:214–27.
>Evers S, Marziniak M. Clinical features, pathophysiology, and treatment of medication-overuse headache. Lancet Neurol. 2010;9(4):391–401.
Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia. 1988;8(Suppl 7):1–96.
The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013;33(9):629–808.
Lanteri-Minet M, Duru G, Mudge M, Cottrell S. Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: a systematic review. Cephalalgia. 2011;31(7):837–50.
Da Silva AN, Lake 3rd AE. Clinical aspects of medication overuse headaches. Headache. 2014;54(1):211–7. Updated Clinical review of MOH.
Colas R, Munoz P, Temprano R, Gomez C, Pascual J. Chronic daily headache with analgesic overuse: epidemiology and impact on quality of life. Neurology. 2004;62(8):1338–42.
Katsarava Z, Obermann M. Medication-overuse headache. Curr Opin Neurol. 2013;26(3):276–81. Broad updated review of MOH.
Ayzenberg I, Katsarava Z, Sborowski A, et al. The prevalence of primary headache disorders in Russia: a countrywide survey. Cephalalgia. 2012;32(5):373–81.
Shahbeigi S, Fereshtehnejad SM, Mohammadi N, et al. Epidemiology of headaches in Tehran urban area: a population-based cross-sectional study in district 8, year 2010. Neurol Sci. 2013;34(7):1157–66.
Linde M, Stovner LJ, Zwart JA, Hagen K. Time trends in the prevalence of headache disorders. The Nord-Trondelag Health Studies (HUNT 2 and HUNT 3). Cephalalgia. 2011;31(5):585–96.
Dyb G, Holmen TL, Zwart JA. Analgesic overuse among adolescents with headache: the Head-HUNT-Youth Study. Neurology. 2006;66(2):198–201.
Wang SJ, Fuh JL, Lu SR, Juang KD. Chronic daily headache in adolescents: prevalence, impact, and medication overuse. Neurology. 2006;66(2):193–7.
Lu SR, Fuh JL, Chen WT, Juang KD, Wang SJ. Chronic daily headache in Taipei, Taiwan: prevalence, follow-up and outcome predictors. Cephalalgia. 2001;21(10):980–6.
Wang SJ, Fuh JL, Lu SR, et al. Chronic daily headache in Chinese elderly: prevalence, risk factors, and biannual follow-up. Neurology. 2000;54(2):314–9.
Meskunas CA, Tepper SJ, Rapoport AM, Sheftell FD, Bigal ME. Medications associated with probable medication overuse headache reported in a tertiary care headache center over a 15-year period. Headache. 2006;46(5):766–72.
Cevoli S, Sancisi E, Grimaldi D, et al. Family history for chronic headache and drug overuse as a risk factor for headache chronification. Headache. 2009;49(3):412–8.
Bahra A, Walsh M, Menon S, Goadsby PJ. Does chronic daily headache arise de novo in association with regular use of analgesics? Headache. 2003;43(3):179–90.
Wilkinson SM, Becker WJ, Heine JA. Opiate use to control bowel motility may induce chronic daily headache in patients with migraine. Headache. 2001;41(3):303–9.
Onaya T, Ishii M, Katoh H, et al. Predictive index for the onset of medication overuse headache in migraine patients. Neurol Sci. 2013;34(1):85–92.
Saper JR, Hamel RL, Lake 3rd AE. Medication overuse headache (MOH) is a biobehavioural disorder. Cephalalgia. 2005;25(7):545–6.
Ferraro S, Grazzi L, Muffatti R, et al. In medication-overuse headache, FMRI shows long-lasting dysfunction in midbrain areas. Headache. 2012;52(10):1520–34.
Fumal A, Laureys S, Di Clemente L, et al. Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. Brain. 2006;129(Pt 2):543–50.
Coppola G, Schoenen J. Cortical excitability in chronic migraine. Curr Pain Headache Rep. 2012;16(1):93–100.
Srikiatkhachorn A, le Grand SM, Supornsilpchai W, Storer RJ. Pathophysiology of medication overuse headache—an update. Headache. 2014;54(1):204–10. Excellent review on pathophysiology of MOH.
Supornsilpchai W, le Grand SM, Srikiatkhachorn A. Cortical hyperexcitability and mechanism of medication-overuse headache. Cephalalgia. 2010;30(9):1101–9.
Coppola G, Curra A, Di Lorenzo C, et al. Abnormal cortical responses to somatosensory stimulation in medication-overuse headache. BMC Neurol. 2010;10:126.
Ferraro S, Grazzi L, Mandelli ML, et al. Pain processing in medication overuse headache: a functional magnetic resonance imaging (fMRI) study. Pain Med. 2012;13(2):255–62.
Ayzenberg I, Obermann M, Nyhuis P, et al. Central sensitization of the trigeminal and somatic nociceptive systems in medication overuse headache mainly involves cerebral supraspinal structures. Cephalalgia. 2006;26(9):1106–14.
De Felice M, Ossipov MH, Wang R, et al. Triptan-induced latent sensitization: a possible basis for medication overuse headache. Ann Neurol. 2010;67(3):325–37.
Johnson JL, Hutchinson MR, Williams DB, Rolan P. Medication-overuse headache and opioid-induced hyperalgesia: a review of mechanisms, a neuroimmune hypothesis and a novel approach to treatment. Cephalalgia. 2013;33(1):52–64.
Srikiatkhachorn A, Anthony M. Platelet serotonin in patients with analgesic-induced headache. Cephalalgia. 1996;16(6):423–6.
Hering R, Glover V, Pattichis K, Catarci T, Steiner TJ. 5HT in migraine patients with medication-induced headache. Cephalalgia. 1993;13(6):410–2.
Srikiatkhachorn A, Anthony M. Serotonin receptor adaptation in patients with analgesic-induced headache. Cephalalgia. 1996;16(6):419–22.
Ayzenberg I, Obermann M, Leineweber K, et al. Increased activity of serotonin uptake in platelets in medication overuse headache following regular intake of analgesics and triptans. J Headache Pain. 2008;9(2):109–12.
Supornsilpchai W, le Grand SM, Srikiatkhachorn A. Involvement of pro-nociceptive 5-HT2A receptor in the pathogenesis of medication-overuse headache. Headache. 2010;50(2):185–97.
Rossi C, Pini LA, Cupini ML, Calabresi P, Sarchielli P. Endocannabinoids in platelets of chronic migraine patients and medication-overuse headache patients: relation with serotonin levels. Eur J Clin Pharmacol. 2008;64(1):1–8.
Hagen K, Linde M, Steiner TJ, Stovner LJ, Zwart JA. Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trondelag Health Studies. Pain. 2012;153(1):56–61.
Curone M, Tullo V, Savino M, Proietti-Cecchini A, Bussone G, D’Amico D. Outcome of patients with chronic migraine with medication overuse and depression after duloxetine: influence of coexisting obsessive compulsive disorder. Neurol Sci. 2013;34 Suppl 1:S175–7.
Hagen K, Linde M, Steiner TJ, Zwart JA, Stovner LJ. The bidirectional relationship between headache and chronic musculoskeletal complaints: an 11-year follow-up in the Nord-Trondelag Health Study (HUNT). Eur J Neurol. 2012;19(11):1447–54.
Hagen K, Vatten L, Stovner LJ, Zwart JA, Krokstad S, Bovim G. Low socio-economic status is associated with increased risk of frequent headache: a prospective study of 22718 adults in Norway. Cephalalgia. 2002;22(8):672–9.
Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache. 2008;48(8):1157–68.
Bigal ME, Lipton RB. Excessive acute migraine medication use and migraine progression. Neurology. 2008;71(22):1821–8.
Limmroth V, Katsarava Z, Fritsche G, Przywara S, Diener HC. Features of medication overuse headache following overuse of different acute headache drugs. Neurology. 2002;59(7):1011–4.
Katsarava Z, Fritsche G, Muessig M, Diener HC, Limmroth V. Clinical features of withdrawal headache following overuse of triptans and other headache drugs. Neurology. 2001;57(9):1694–8.
Scher AI, Stewart WF, Lipton RB. Caffeine as a risk factor for chronic daily headache: a population-based study. Neurology. 2004;63(11):2022–7.
Tepper SJ. Medication-overuse headache. Continuum (Minneap Minn). 2012;18(4):807–22.
Dousset V, Maud M, Legoff M, et al. Probable medications overuse headaches: validation of a brief easy-to-use screening tool in a headache centre. J Headache Pain. 2013;14:81.
Creac’h C, Radat F, Mick G, et al. One or several types of triptan overuse headaches? Headache. 2009;49(4):519–28.
Grande RB, Aaseth K, Benth JS, Lundqvist C, Russell MB. Reduction in medication-overuse headache after short information. The Akershus study of chronic headache. Eur J Neurol. 2011;18(1):129–37.
Rossi P, Di Lorenzo C, Faroni J, Cesarino F, Nappi G. Advice alone vs. structured detoxification programmes for medication overuse headache: a prospective, randomized, open-label trial in transformed migraine patients with low medical needs. Cephalalgia. 2006;26(9):1097–105.
Saper JR, Da Silva AN. Medication overuse headache: history, features, prevention and management strategies. CNS Drugs. 2013;27(11):867–77. Updated review on MOH including prevention and treatment approach.
Saper JR, Lake 3rd AE. Medication overuse headache: type I and type II. Cephalalgia. 2006;26(10):1262.
Evers S, Jensen R. Treatment of medication overuse headache—guideline of the EFNS headache panel. Eur J Neurol. 2011;18(9):1115–21.
Zeeberg P, Olesen J, Jensen R. Discontinuation of medication overuse in headache patients: recovery of therapeutic responsiveness. Cephalalgia. 2006;26(10):1192–8.
Boe MG, Salvesen R, Mygland A. Chronic daily headache with medication overuse: predictors of outcome 1 year after withdrawal therapy. Eur J Neurol. 2009;16(6):705–12.
Pascual J, Berciano J. [Daily chronic headache in patients with migraine induced by abuse of ergotamine-analgesics: response due to a protocol of outpatient treatment]. Neurologia. 1993;8(7):212–5.
Smith TR. Low-dose tizanidine with nonsteroidal anti-inflammatory drugs for detoxification from analgesic rebound headache. Headache. 2002;42(3):175–7.
Rabe K, Pageler L, Gaul C, et al. Prednisone for the treatment of withdrawal headache in patients with medication overuse headache: a randomized, double-blind, placebo-controlled study. Cephalalgia. 2013;33(3):202–7.
Boe MG, Mygland A, Salvesen R. Prednisolone does not reduce withdrawal headache: a randomized, double-blind study. Neurology. 2007;69(1):26–31.
Pageler L, Katsarava Z, Diener HC, Limmroth V. Prednisone vs. placebo in withdrawal therapy following medication overuse headache. Cephalalgia. 2008;28(2):152–6.
Lu SR, Fuh JL, Juang KD, Wang SJ. Repetitive intravenous prochlorperazine treatment of patients with refractory chronic daily headache. Headache. 2000;40(9):724–9.
Raskin NH. Repetitive intravenous dihydroergotamine as therapy for intractable migraine. Neurology. 1986;36(7):995–7.
Williams DR, Stark RJ. Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse. Cephalalgia. 2003;23(10):963–71.
Schwartz TH, Karpitskiy VV, Sohn RS. Intravenous valproate sodium in the treatment of daily headache. Headache. 2002;42(6):519–22.
Trucco M, Meineri P, Ruiz L, Gionco M. Medication overuse headache: withdrawal and prophylactic therapeutic regimen. Headache. 2010;50(6):989–97.
Tassorelli C, Jensen R, Allena M, et al. A consensus protocol for the management of medication-overuse headache: evaluation in a multicentric, multinational study. Cephalalgia. Feb 20 2014. Protocol for managing MOH.
Diener HC, Dodick DW, Goadsby PJ, et al. Utility of topiramate for the treatment of patients with chronic migraine in the presence or absence of acute medication overuse. Cephalalgia. 2009;29(10):1021–7.
Russell MB, Lundqvist C. Prevention and management of medication overuse headache. Curr Opin Neurol. 2012;25(3):290–5.
Aurora SK, Dodick DW, Turkel CC, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia. 2010;30(7):793–803.
Diener HC, Dodick DW, Aurora SK, et al. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia. 2010;30(7):804–14.
Silberstein SD, Blumenfeld AM, Cady RK, et al. OnabotulinumtoxinA for treatment of chronic migraine: PREEMPT 24-week pooled subgroup analysis of patients who had acute headache medication overuse at baseline. J Neurol Sci. 2013;331(1–2):48–56.
Bendtsen L, Munksgaard S, Tassorelli C, et al. Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project). Cephalalgia. Dec 9 2013.
Lai JT, Dereix JD, Ganepola RP, et al. Should we educate about the risks of medication overuse headache? J Headache Pain. 2014;15:10.
Hagen K, Albretsen C, Vilming ST, et al. A 4-year follow-up of patients with medication-overuse headache previously included in a randomized multicentre study. J Headache Pain. 2011;12(3):315–22.
Grazzi L, Andrasik F, D’Amico D, et al. Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years. Headache. 2002;42(6):483–90.
Katsarava Z, Muessig M, Dzagnidze A, Fritsche G, Diener HC, Limmroth V. Medication overuse headache: rates and predictors for relapse in a 4-year prospective study. Cephalalgia. 2005;25(1):12–5.
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(7):481–5. discussion 461.
Compliance with Ethics Guidelines
Conflict of Interest
Valerie Cheung and Farnaz Amoozegar declare that they have no conflict of interest.
Esma Dilli has received speaker honorarium from Allergen and Tribune (Cambia).
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.
Author information
Authors and Affiliations
Additional information
This article is part of the Topical Collection on Headache
Rights and permissions
About this article
Cite this article
Cheung, V., Amoozegar, F. & Dilli, E. Medication Overuse Headache. Curr Neurol Neurosci Rep 15, 509 (2015). https://doi.org/10.1007/s11910-014-0509-x
Published:
DOI: https://doi.org/10.1007/s11910-014-0509-x