Abstract
Medication-overuse headache (MOH) is a relatively common and impactful disorder, affecting 1% to 2% of the population, characterized by daily or near-daily headache aggravated by chronic acute medication intake. Primary headache patients do not necessarily develop MOH after acute medication overuse, although a pre-existing primary headache is inevitably present. Likewise, headache patients may deteriorate in terms of frequency without medication overuse, or suffer from chronic headache in the presence of drug abuse without any causal relationship. To classify and define diagnostic criteria for MOH in the absence of objective biomarkers is a difficult task that is presently based on clinical grounds and is limited in part by the relative lack of research in this field. The present criteria are less restrictive but also less precise than the previous versions because they allow the diagnosis without the previously required MOH confirmation after medication withdrawal. MOH should remain as a distinct secondary disorder based on the available clinical and pathophysiological evidence.
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Osler W, Bean RB. Sir William Osler: aphorisms from his bedside teachings and writings. 2nd ed. Springfield: Charles C. Thomas; 1961.
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders. Cephalalgia. 2004;24 Suppl 1.
Jonsson P, Hedenrud T, Linde M. Epidemiology of medication overuse headache in the general Swedish population. Cephalalgia. 2011;31(9):1015–22.
Aaseth K, Grande RB, Kvaerner KJ, Gulbrandsen P, Lundqvist C, Russell MB. Prevalence of secondary chronic headaches in a population-based sample of 30-44-year-old persons. The Akershus study of chronic headache. Cephalalgia. 2008;28(7):705–13.
Colas R, Munoz P, Temprano R, Gomez C, Pascual J. Chronic daily headache with analgesic overuse: epidemiology and impact on quality of life. Neurology, EUA. 2004;62(8):1338–42.
Katsarava Z, Dzagnidze A, Kukava M, Mirvelashvili E, Djibuti M, Janelidze M, et al. Primary headache disorders in the Republic of Georgia: prevalence and risk factors. Neurology, EUA. 2009;73(21):1796–803.
Straube A, Pfaffenrath V, Ladwig KH, Meisinger C, Hoffmann W, Fendrich K, et al. Prevalence of chronic migraine and medication overuse headache in Germany—the German DMKG headache study. Cephalalgia. 2010;30(2):207–13.
Bigal ME, Rapoport AM, Sheftell FD, Tepper SJ, Lipton RB. Transformed migraine and medication overuse in a tertiary headache centre—clinical characteristics and treatment outcomes. Cephalalgia. 2004;24(6):483–90.
Katsarava Z, Schneeweiss S, Kurth T, Kroener U, Fritsche G, Eikermann A, et al. Incidence and predictors for chronicity of headache in patients with episodic migraine. Neurology, EUA. 2004;62(5):788–90.
•• Ashina S, Lyngberg A, Jensen R. Headache characteristics and chronification of migraine and tension-type headache: a population-based study. Cephalalgia. 2010;30(8):943–52. This comprehensive cross-sectional and longitudinal population study involving 740 individuals (with 673 eligible for follow-up) addresses risk factors for migraine and tension-type headache chronification.
Lyngberg AC, Rasmussen BK, Jorgensen T, Jensen R. Prognosis of migraine and tension-type headache: a population-based follow-up study. Neurology, EUA. 2005;65(4):580–5.
Scher AI, Midgette LA, Lipton RB. Risk factors for headache chronification. Headache. 2008;48(1):16–25.
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.
Radat F, Creach C, Swendsen JD, Lafittau M, Irachabal S, Dousset V, et al. Psychiatric comorbidity in the evolution from migraine to medication overuse headache. Cephalalgia. 2005;25(7):519–22.
Cevoli S, Sancisi E, Grimaldi D, Pierangeli G, Zanigni S, Nicodemo M, et al. Family history for chronic headache and drug overuse as a risk factor for headache chronification. Headache. 2009;49(3):412–8.
Di Lorenzo C, Di Lorenzo G, Sances G, Ghiotto N, Guaschino E, Grieco GS, et al. Drug consumption in medication overuse headache is influenced by brain-derived neurotrophic factor Val66Met polymorphism. J Headache Pain. 2009;10(5):349–55.
Cevoli S, Mochi M, Scapoli C, Marzocchi N, Pierangeli G, Pini LA, et al. A genetic association study of dopamine metabolism-related genes and chronic headache with drug abuse. Eur J Neurol. 2006;13(9):1009–13.
Gelernter J, Kranzler HR, Satel SL, Rao PA. Genetic association between dopamine transporter protein alleles and cocaine-induced paranoia. Neuropsychopharmacology. 1994;11(3):195–200.
Laine TP, Ahonen A, Rasanen P, Pohjalainen T, Tiihonen J, Hietala J. The A1 allele of the D2 dopamine receptor gene is associated with high dopamine transporter density in detoxified alcoholics. Alcohol Alcohol. 2001;36(3):262–5.
Ayzenberg I, Obermann M, Nyhuis P, Gastpar M, Limmroth V, Diener HC, 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.
Schmidt-Wilcke T, Leinisch E, Straube A, Kampfe N, Draganski B, Diener HC, et al. Gray matter decrease in patients with chronic tension type headache. Neurology, EUA. 2005;65(9):1483–6.
Fumal A, Laureys S, Di Clemente L, Boly M, Bohotin V, Vandenheede M, et al. Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. Brain. 2006;129(Pt 2):543–50.
London ED, Ernst M, Grant S, Bonson K, Weinstein A. Orbitofrontal cortex and human drug abuse: functional imaging. Cereb Cortex. 2000;10(3):334–42.
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.
Silberstein SD, Olesen J, Bousser MG, Diener HC, Dodick D, First M, et al. The International Classification of Headache Disorders, 2nd Edition (ICHD-II)—revision of criteria for 8.2 Medication-overuse headache. Cephalalgia. 2005;25(6):460–5.
• Sun-Edelstein C, Bigal ME, Rapoport AM. Chronic migraine and medication overuse headache: clarifying the current International Headache Society classification criteria. Cephalalgia. 2009;29(4):445–52. This article analyzes controversies focusing chronic migraine (CM) and medication-overuse headache (MOH) to address confusion among different terms referring to frequent headaches. The authors favor the incorporation of the ICHD-IIR proposal for the diagnosis of CM and MOH because it addresses problems related to the previous classification version. The possibility of identifying MOH patients without necessarily proving that the headache was produced by the offending drug after withdrawal and new possibilities of classifications according to the abuse of combined medications are discussed.
Cady RK, Lipton RB, Hall C, Stewart WF, O'Quinn S, Gutterman D. Treatment of mild headache in disabled migraine sufferers: results of the Spectrum Study. Headache. 2000;40(10):792–7.
Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, et al. New appendix criteria open for a broader concept of chronic migraine. Cephalalgia. 2006;26(6):742–6.
• Ferrari A, Coccia C, Sternieri E. Past, present, and future prospects of medication-overuse headache classification. Headache. 2008;48(7):1096–102. The authors made an objective review analyzing the past and present aspects concerning the classification of headaches related to medication overuse. They suggest the categories probable and definite medication-overuse headache (MOH) should remain, and propose subforms of MOH according to the class of abused drugs.
Saper JR, Lake 3rd AE. Medication overuse headache: type I and type II. Cephalalgia. 2006;26(10):1262.
Saper JR, Hamel RL, Lake 3rd AE. Medication overuse headache (MOH) is a biobehavioural disorder. Cephalalgia. 2005;25(7):545–6.
Disclosures
Dr. Maurice Vincent has served as a board member for Allergan, receiving travel expense compensation from the company for attending meetings.
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Vincent, M.B. Controversy over the Classification of Medication-Overuse Headache. Curr Pain Headache Rep 16, 80–85 (2012). https://doi.org/10.1007/s11916-011-0229-8
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DOI: https://doi.org/10.1007/s11916-011-0229-8