Medication Overuse Headache

Medication Overuse Headache
Medication overuse headache (MOH) is a headache occurring on 15 or more days per month from regular overuse of acute headache medication for more than 3 months. Many acute symptomatic medications used to treat headaches have the potential for causing MOH. Risk is highest with opioids, butalbital-containing combination analgesics, and acetaminophen-aspirin-caffeine combinations. Triptans (sumatriptan, rizatriptan etc.) have moderate risks and some studies indicate NSAIDs (ibuprofen, naproxen, diclofenac, indomethacin etc.) also has high risks.
A history of symptomatic medication use for more than two to three days per week in association with chronic daily headache is suggestive of MOH. Nausea, asthenia, difficulty concentrating, memory problems, and irritability can accompany MOH.
The precise mechanisms that lead to MOH are still uncertain. However, multiple factors seem to play a role, including genetic predisposition, sensitization of pain processing, and biobehavioral factors.
The management of MOH includes patient education, initiation of effective preventive therapy, discontinuation of the overused medication (through tapering down or with assistance of bridge therapy), and follow-up to prevent relapse.
If you are experiencing headaches for 15+ days a month, please make an appointment with a MCHN provider for an evaluation.
–Alice Wong, NP