Medication overuse or rebound headache (MOH) is a secondary chronic daily headache (CDH), defined by a worsening and transformation of episodic migraine into daily or near-daily headache, associated with overuse of acute anti-migraine medications. The frequency at which acute medication results in MOH varies, and can be as little as 5 days of use per month for butalbital, 8 days per month for narcotics, and 10 days per month for triptans and NSAIDs.
Prevention of MOH is encouraged by using headache diaries to keep number of headache days per month low with optimal use of acute medications, and intervention with preventive medications when appropriate. Treatment of MOH is predicated on absolute wean of overused medications, establishing prophylaxis, providing migraine-specific acute medications with limits, and behavioral and educational interventions and therapies. Limiting acute medication use to 2 days per week is a prudent first step.
This is a preview of subscription content, log in to check access
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;48:1157–68.PubMedCrossRefGoogle Scholar
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. 2004;62:788–90.PubMedGoogle Scholar
Lake 3rd AE, Saper JR, Hamel RL. Comprehensive inpatient treatment of refractory chronic daily headache. Headache. 2009;49:555–62.PubMedCrossRefGoogle Scholar
Lipton RB, Stewart WF, Stone AM, Lainez MJ, Sawyer JP. Stratified care vs. step care strategies for migraine. The disability in strategies of care (DISC) study. JAMA. 2000;284:2599–605.PubMedCrossRefGoogle Scholar
Loder E, Biondi D. Oral phenobarbital loading: a safe and effective method of withdrawing patients with headache from butalbital compounds. Headache. 2003;43:904–9.PubMedCrossRefGoogle Scholar
Mathew NT, Kurman R, Perez F. Drug induced refractory headache – clinical features and management. Headache. 1990;30:634–8.PubMedCrossRefGoogle Scholar
Raskin NH. Repetitive intravenous dihydroergotamine as therapy for intractable migraine. Neurology. 1986;36:995–7.PubMedGoogle Scholar
Scher AI, Stewart WF, Ricci JA, Lipton RB. Factors associated with the onset and remission of chronic daily headache in a population-based study. Pain. 2003;106:81–9.PubMedCrossRefGoogle Scholar
Sheftell FD, Brunton SA, Coon TL, Hutchinson SL, Kaniecki RG. Chronic daily headache: understanding and treating a common malady. Fam Pract Recert. 2004;6:25–36.Google Scholar
Zed PJ, Loewen PS, Robinson G. Medication-induced headache: overview and systematic review of therapeutic approaches. Ann Pharmacother. 1999;33:61–72.PubMedCrossRefGoogle Scholar