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.
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