Materiały źródłowe

• #1 Medication-overuse headache: epidemiology, diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4110872/

  Medication-overuse headache (MOH) is one of the most common chronic headache disorders and a public health problem with a worldwide prevalence of 12%. […] The treatment of MOH is often complex and withdrawal of the overused medication is recognised as the treatment of choice. […] This review will attempt to give an up-to-date focus on epidemiology, diagnosis and different aspects of the management, treatment and prevention of MOH. […] MOH is headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more, or 15 or more days per month, depending on the medication) for more than 3 months. […] The prevalence of MOH in the general population is 12%. […] The risk of developing MOH is greater in individuals with a family history of MOH or other substance abuse.

• #1 8.2 Medication-overuse headache (MOH) – ICHD-3

  https://ichd-3.org/8-headache-attributed-to-a-substance-or-its-withdrawal/8-2-medication-overuse-headache-moh/

  8.2 Medication-overuse headache (MOH) […] Headache occurring on 15 or more days/month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more or 15 or more days/month, depending on the medication) for more than 3 months. It usually, but not invariably, resolves after the overuse is stopped. […] Diagnostic criteria: […] 1. Headache occurring on ≥15 days/month in a patient with a pre-existing headache disorder […] 2. Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache […] 3. Not better accounted for by another ICHD-3 diagnosis. […] 8.2 Medication-overuse headache is an interaction between a therapeutic agent used excessively and a susceptible patient. Among those with a previous primary headache diagnosis, most have 1. Migraine or 2. Tension-type headache (or both); only a small minority have other primary headache disorders such as 3.3 Chronic cluster headache or 4.10 New daily persistent headache.

• #1 Medication overuse headache – The Migraine TrustVisualV1 – SearchVisualV1 – CrossVisualV1 – Home VisualV1 – CrossVisualV1 – Arrow

  https://migrainetrust.org/understand-migraine/types-of-migraine/medication-overuse-headache/

  A headache that results from the frequent use of acute medicines or painkillers. […] Your doctor may diagnose MOH if you are regularly taking high levels of acute medicines (painkillers) for at least three months. This includes: paracetamol and NSAIDs (simple analgesics) on 15 or more days per month […] or ergotamine, triptans, opioids (codeine-based medicines) as well as combination painkillers on 10 or more days per month.

• #1 Medication-overuse headache: a widely recognized entity amidst ongoing debate | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0875-x

  The first edition of the International Classification of Headache Disorders (ICHD) was published in 1988 which introduced the term drug-induced headache. […] The term medication-overuse headache was first introduced in the second edition of the ICHD in 2004. […] The diagnostic criteria included a mandatory prerequisite that the headache syndrome resolved or reverted to the previous pattern within 2 months after discontinuation of the overused drug. […] This caused the entity of definite MOH to be diagnosed retrospectively and more difficult to handle in clinical practice. […] The criterion was changed in 2006 when a board of experts published revisions by consensus and introduced a broader concept of MOH, in which the diagnosis was based on headache frequency (equal to or greater than 15 days/month) and overuse of headache medication, but did not require the headache to improve after withdrawal. […] This criterion was omitted again in the latest and current Third Edition of the International Classification of Headache Disorders (ICHD-3).

• #1 Medication overuse headaches – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/medication-overuse-headache/diagnosis-treatment/drc-20377089

  Your healthcare professional most often can diagnose medication overuse headaches based on your history of headaches and your use of medicine. Most people don’t need testing. People who are diagnosed with medication overuse disorder have a headache condition, have headaches on 15 or more days a month for more than three months, and take too much headache medicine. […] For medication overuse headaches, some questions to ask include: How does medicine I take to treat headaches cause headaches? Could there be other reasons for my headaches? How can I stop these headaches? If I keep getting headaches, how can I treat them? Are there brochures or other printed material I can have? What websites do you suggest? […] Your healthcare professional will ask questions about your headaches, such as when they started and what they feel like. Questions might include: What type of headache do you most often have? Have your headaches changed in the past six months? How bad are your symptoms? What headache medicines do you use, and how often? Have you increased the amount of headache medicines you take or how often you take them? What side effects have you had from medicines? Does anything make your symptoms better? What, if anything, makes your symptoms worse?

• #1 Medication-Overuse Headache

  https://practicalneurology.com/diseases-diagnoses/headache-pain/medication-overuse-headache-1/31661/

  Clinical features of MOH are often similar to the underlying primary headache disorder, although people often state they can tell the difference between their MOH attacks and those of their primary headache disorder. For example, in people with migraine, headaches from overuse will also be migraine-like in nature. This contributes to the complexity of making a diagnosis of MOH. In order to make the diagnosis, a comprehensive medical history needs to be obtained along with the history of acute medication use for both the primary headache disorder and other pain syndromes. […] The diagnostic criteria for MOH do not demonstrate the complexity of making the diagnosis of MOH. It is important to realize that medication overuse and MOH are 2 different problems that can have different complications and outcomes.

• #1

  https://ihs-headache.org/en/resources/medication-overuse-headache-awareness-campaign/

  Another tool extremely important for diagnosing MOH is a headache diary or calendar, where the patient has to input the headache days and the days of use of acute medications. […] The diagnostic criteria of the International Classification of Headache Disorders (3rd edition) for MOH, which are shown here, are very simple and almost purely mathematical in their application. […] Individuals receive a diagnosis of MOH along with the pre-existing headache diagnosis, usually migraine, less frequently tension-type headache, occasionally other headache types. […] While this correlation almost totally relies on patients recall, with the attached bias, it should always be searched by the clinician with an accurate history taking and, possibly, via health records or claims.

• #1 Medication overuse headache • LITFL • Neurology library

  https://litfl.com/medication-overuse-headache/

  Medication overuse headache is defined as a preexisting primary headache that has worsened significantly, or has evolved into a new type of headache, in association with medication overuse. […] In the International Classification of Headache Disorders (ICHD-3), medication overuse headache is a separate entity next to mostly primary headache disorders. […] Eliciting the information required to render this diagnosis may be difficult, as the patient may not fully reveal their use of medicines. […] A headache diary and careful history of drug intake is key to affirming the diagnosis.

• #1 8.2 Medication-overuse headache (MOH) – ICHD-3

  https://ichd-3.org/8-headache-attributed-to-a-substance-or-its-withdrawal/8-2-medication-overuse-headache-moh/

  The diagnosis of 8.2 Medication-overuse headache is extremely important clinically. Epidemiological evidence from many countries indicates that more than half of people with headache on 15 or more days/month have 8.2 Medication-overuse headache. Clinical evidence shows that the majority of patients with this disorder improve after discontinuation of the overused medication, as does their responsiveness to preventative treatment. Simple advice on the causes and consequences of 8.2 Medication-overuse headache is an essential part of its management and can be provided with success in primary care. An explanatory brochure is often all that is necessary to prevent or discontinue medication overuse. Prevention is especially important in patients prone to frequent headache. […] The behaviour of some patients with 8.2 Medication-overuse headache is similar to that seen with other drug addictions, and the Severity of Dependence Scale (SDS) score is a significant predictor of medication overuse among headache patients.

• #1 Medication-Overuse Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538150/

  Diagnosis of Medication-overuse Headache (MOH) According to ICHD-3 Must Meet Criteria A-C for the Diagnosis of MOH: Headache on 15 or more days per month AND a pre-existing headache disorder; Overuse of acute and/or symptomatic headache drugs for over three months; No better explanation by another ICHD-3 diagnosis. […] The management approach includes patient education, effective prophylaxis, discontinuation of the overused analgesic, and follow-up to prevent a recurrence. […] MOH is felt to be a preventable disease; therefore, the emphasis should be on educating patients on the importance of appropriate medication administration and the risks not only of its side effects but also the potential development of chronic headaches with excessive medication use is essential. […] The differential diagnosis of MOH would include any form of chronic daily headache, whether it is a primary or secondary headache diagnosis, including migraine, tension-type headache, cluster headache, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), hypnic headache, nummular headache, and chronic paroxysmal hemicrania. […] Always ask patients about a history of head trauma, and if a patient’s history or physical examination causes concern, then appropriate diagnostic testing should be performed to rule out the possibility of a severe medical or neurologic condition.

• #1 Medication overuse headache – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000344

  Medication overuse headache (MOH) is a chronic secondary headache condition attributable to overuse of acute medication(s) by an individual with a preexisting primary headache disorder (almost always migraine or tension-type headache). Patients with MOH suffer from a headache on more days than not. […] MOH is a clinical diagnosis based on careful history-taking and use of a headache diary, together with a normal neurologic examination. No investigations are required unless there are red flag symptoms or signs that suggest the need to exclude an alternative, more serious cause for the headache. […] Key diagnostic factors include underlying primary headache disorder, headache on 15 days per month, and overuse of acute headache medication for 3 months. […] Other diagnostic factors include a normal neurologic exam and absence of red flag symptoms and/or signs.

• #1 Medication overuse headache – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/3000344

  The typical history is for the primary headaches to increase in frequency, accompanied by escalated intake of acute headache medications, leading to a transition from an episodic to chronic headache. […] Diagnostic tests include clinical diagnosis as the first tests to order, with MRI brain, CT brain, CRP/erythrocyte sedimentation rate (ESR), lumbar puncture (LP), and cerebrospinal fluid (CSF) culture as tests to consider.

• #1 Medication Overuse Headache – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/headache/medication-overuse-headache

  No other headache type that better accounts for the clinical presentation. […] Medication overuse headache must be differentiated from the primary headache disorder, which typically causes concurrent symptoms. […] Routine neuroimaging is unnecessary. Rarely, CT or MRI is done to exclude other disorders.

• #1 Medication overuse headaches – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/medication-overuse-headache/symptoms-causes/syc-20377083

  Medication overuse headaches are the result of the long-term use of medicines needed to treat headaches such as migraines. […] Medication overuse headaches most often go away after stopping the pain medicine. […] Talk with your healthcare professional if: […] You take a pain reliever for your headaches more than twice a week. […] Experts don’t know exactly why medication overuse headaches happen. […] Risk factors for getting medication overuse headaches include: […] A long-term history of headaches, especially migraines, raises the risk. […] Medication overuse headache often occurs when a headache condition such as migraine is not well controlled and may make the underlying headache condition difficult to treat. […] Your risk goes up if you use combined painkillers, opioids, ergotamine or triptans 10 or more days a month. […] Taking care of yourself can help prevent most headaches. […] Contact your healthcare professional if you need headache medicine more than twice a week. […] Don’t take medicines that have butalbital or opioids if possible.

• #1 Medication-Overuse Headache

  https://practicalneurology.com/diseases-diagnoses/headache-pain/medication-overuse-headache-1/31661/

  In both cases, individuals with chronic migraine had increased frequency of migraine and overuse of triptan for more than 10 days / month for longer than 3 months. Both meet the diagnostic criteria for triptan-related MOH. However, Ms. A keeps meticulous calendars of her headache frequency and worsening of migraine 1 month before triptan use was more frequent than 10 days/month. […] The start of a preventive treatment option that is focused on reducing the frequency of the primary headache disorder should be done at the same time as education. Clinical trials have restricted the participation of individuals with MOH. More recent trials, however, including those for onabotulinum toxin A and calcitonin gene-related peptide antagonists, have allowed participation of people with MOH and shown that these individuals can experience migraine frequency reduction without withdrawal in acute medication use.

• #1 Medication-overuse Headache | Which medicines cause headache?

  https://patient.info/brain-nerves/headache-leaflet/medication-overuse-headache

  Medication-overuse headache is a cause of frequent headaches caused by taking painkillers or triptan medicines regularly for headaches or migraine. […] Medication-overuse headache (medication-induced headache) is a type of headache that is caused by using headache-relief medications (pain relievers or triptans) too often. […] The diagnosis of medication-overuse headache is very important as, when overusing medication in this way, other treatments (such as headache preventers) are unlikely to work. […] The headaches must resolve – or your headaches must go back to the pattern of pain you had before the problem started – within two months of stopping overuse if the diagnosis is to be definite. Until then, your diagnosis will be 'probable medication-overuse headache’. It is only after you are better that you and your doctor can be absolutely certain.

• #1 Medication overuse headache | Great Ormond Street Hospital

  https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/medication-overuse-headache/

  Medication overuse headache (MOH) develops and gets worse with frequent use of any medication treatment for headache or migraine. […] MOH occurs when a child or young person has been using painkiller medications for three months or more, leading to worsening chronic headaches. […] MOH is a treatable condition and requires that the child affected stops using the medications for the headache to resolve. […] If there is no improvement in the headaches after stopping the medications, then the diagnosis of MOH may need to be reconsidered.

• #1 Medication Overuse Headache a Pain to Treat

  https://www.medscape.com/viewarticle/ehc-2023-medication-overuse-headache-pain-treat-2023a1000ukg

  Around half of all patients with chronic headache or migraine overuse their medication, leading to aggravated or new types of headaches. „Medication overuse headache” is the third most frequent type of headache, affecting some 60 million people or around 1% of the world’s population. […] „But it’s important to distinguish between medication overuse, which is a behavior, and medication overuse headache, which is a distinct secondary order condition.” […] Medication overuse headache is characterized by an increasing headache frequency and progressive use of short-term medication and is recognized as a major factor in the shift from episodic to chronic headache. […] Recognition that headache medication is being overused is a crucial first step to treatment, followed by advising the patient to discontinue the medication.

• #1 Medication-overuse headache: a narrative review | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01755-w

  The development of gepants, CGRP receptor antagonists, for the preventive treatment of migraine offers an important advance since if these medicines, useful also for acute treatment do not cause MOH, this would be a crucial advance. […] A study led by Fritsche and colleagues suggested that patients who were made aware of the prevention of MOH, through bibliotherapy resulted in no development of MOH in the study group and resulted in a significant reduction in both headache days and pain-related parameters. […] The results indicated that patients with CM and MOH treated with eptinezumab displayed a reduction in monthly migraine days compared to placebo.

• #1 Medication-Overuse Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538150/

  The most common headache diagnoses before the evolution of MOH are migraines (65%), tension-type headaches (27%), and mixed/other headaches (8%). […] The central sensitization caused by MOH can lead to skin hypersensitivity and the expansion of their headache. […] A false-positive diagnosis must be excluded by obtaining a detailed history and physical examination, including headache type, frequency, and drug use, to rule out any secondary headache syndromes that may require different management. […] Remember, it is the frequency of a headache and not the quality or intensity that makes the diagnosis of MOH. […] Unless there are concerning clinical features in the patient’s history or physical examination, there are no confirmatory nor necessary laboratory, radiographic or other tests required to diagnose MOH.

• #1 Medication overuse headache: Treatment and prognosis – UpToDate

  https://www.uptodate.com/contents/medication-overuse-headache-treatment-and-prognosis

  Medication overuse headache (MOH) is a secondary headache condition that occurs when overuse of acute medications to treat other headache disorders results in an increased headache burden with attacks occurring on 15 or more days per month for at least three months. MOH has also been called analgesic rebound headache, drug-induced headache, medication adaptation headache, and medication-misuse headache. It requires an effective treatment strategy of withdrawing the overused medication to reduce headache burden and permit more effective treatment of the underlying headache disorder. […] This topic will review the treatment and prognosis of MOH. The causes, clinical features, and diagnosis of MOH are discussed separately. […] Treatment begins with patient education about the detrimental effects of overuse of medications used for acute headache treatment. Patients need to understand that underutilization of preventive therapies and/or excessive exposure to acute medications has the potential to worsen headache symptoms, leading to MOH, and also may cause medication adverse effects or toxicities. […] Some evidence suggests many patients are unaware of MOH, indicating that primary prevention via education and advice is essential.

• #2 Medication-overuse headache: a widely recognized entity amidst ongoing debate | The Journal of Headache and Pain | Full Text

  https://thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-018-0875-x

  To establish the diagnosis, patients have to use symptomatic headache medication on more than 10 or more than 15 days per month, depending on the drug class, for more than 3 months. […] The prevalence of medication overuse is higher in studies from headache specialist centers, with numbers ranging from 30% to 50% of patients. […] A comprehensive medical history, clinical examination and the use of internationally accepted criteria and guidelines are the required tools for the diagnosis of MOH. […] The headache phenotype of MOH may be indistinguishable from other forms of chronic daily headache. […] Awareness for potential secondary headache syndromes is required and red flags have to be searched for in order to avoid a false-positive diagnosis of MOH in escalating headache disorders, some of which may require medical imaging or lumbar puncture.

• #2 Medication-Overuse Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK538150/

  Diagnosis of Medication-overuse Headache (MOH) According to ICHD-3 Must Meet Criteria A-C for the Diagnosis of MOH: Headache on 15 or more days per month AND a pre-existing headache disorder; Overuse of acute and/or symptomatic headache drugs for over three months; No better explanation by another ICHD-3 diagnosis. […] The management approach includes patient education, effective prophylaxis, discontinuation of the overused analgesic, and follow-up to prevent a recurrence. […] MOH is felt to be a preventable disease; therefore, the emphasis should be on educating patients on the importance of appropriate medication administration and the risks not only of its side effects but also the potential development of chronic headaches with excessive medication use is essential. […] The differential diagnosis of MOH would include any form of chronic daily headache, whether it is a primary or secondary headache diagnosis, including migraine, tension-type headache, cluster headache, short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT), hypnic headache, nummular headache, and chronic paroxysmal hemicrania. […] Always ask patients about a history of head trauma, and if a patient’s history or physical examination causes concern, then appropriate diagnostic testing should be performed to rule out the possibility of a severe medical or neurologic condition.

• #2 Medication Overuse Headache – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/headache/medication-overuse-headache

  Medication overuse headache is a chronic headache that occurs 15 days/month in patients who regularly overuse headache medication for 3 months. […] Diagnosis of medication overuse headache is clinical and is based upon the frequency of headache and overuse of medications to relieve it. […] According to the International Classification of Headache Disorders (1), the criteria for the diagnosis of medication overuse headache include headache that occurs 15 days a month in a patient with a preexisting headache disorder. […] Regular overuse of one or more medications taken for acute treatment of headache for 3 months (medications include ergotamine, triptans, opioids, or mixed analgesics taken 10 days a month or a single nonopioid analgesic such as acetaminophen, aspirin, or another NSAID taken 15 days/month).

• #2 Medication-Overuse Headache: Update on Management

  https://www.mdpi.com/2075-1729/14/9/1146

  Medication-overuse headache (MOH) can be diagnosed in patients with a pre-existing primary headache, who have headaches occurring on 15 or more days per month and regularly overuse acute treatments for more than 10–15 days per month for three consecutive months. […] The latest criteria were modified from previous ICHD-2 criteria by removing the following two requirements: (1) headache resolves to its previous pattern within 2 months after the discontinuation of overused medication and (2) headache develops or markedly worsens during medication-overuse. […] In clinical practice, an MOH most often develops in those with a migraine (or less commonly in a tension-type headache) who report an increased frequency of headaches on a recent background of frequent acute medication use. […] Diagnosis can be difficult because the transition from episodic to chronic migraines or tension-type headaches often induces a more regular use of analgesics.

• #2 Medication-Overuse Headache: Update on Management

  https://www.mdpi.com/2075-1729/14/9/1146

  Although MOH are a common secondary headache disorder, it is important to consider the other secondary causes of chronic headaches before making a diagnosis, including life-threatening conditions such as mass-occupying or vascular lesions; intracranial hypertension; intracranial hypotension; systemic symptoms suggest malignancy or vasculitis; and obstructive sleep apnea. […] The pathophysiology of MOH remains poorly understood but is likely to involve both the peripheral and central neuronal networks associated with the chronification of pain. […] An MOH has no distinguishing features and there are no specific laboratory tests that support diagnosis. […] The overall risk of developing MOH is therefore complex and relates to the interplay between certain psycho-social factors and the class of acute medication that is overused in genetically predisposed individuals.

• #2

  https://journals.lww.com/painrpts/fulltext/2017/08000/preventing_and_treating_medication_overuse.11.aspx

  Keeping a headache diary with detailed information about medication use for a minimum of 4 weeks is a very helpful tool to document MOH. […] When deciding how to treat the patient, we may find it useful to categorize patients into 2 groups: relatively uncomplicated cases (type I, no behavioral impairment and no overuse of barbiturates or opioids) and complicated cases (type II, significant psychological issues and/or overuse of barbiturates and/or opioids). […] There is no universal consensus on how to treat MOH, and we lack evidence from sufficiently powered randomized clinical trials (RCTs) to recommend one specific treatment approach. […] Most experts now regard withdrawal of the overused medication as the treatment of choice, as it often leads to improvement of the headache. […] In general, around 50% to 70% of patients with MOH seem to respond well to withdrawal therapy, and no withdrawal regime seems to be superior.

• #2 Medication Overuse Headache – Neurologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/neurologic-disorders/headache/medication-overuse-headache

  No other headache type that better accounts for the clinical presentation. […] Medication overuse headache must be differentiated from the primary headache disorder, which typically causes concurrent symptoms. […] Routine neuroimaging is unnecessary. Rarely, CT or MRI is done to exclude other disorders.

• #2 Medication-overuse headache: clinical profile and management strategies | Neurosciences Journal

  https://nsj.org.sa/content/28/1/13

  Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders 3rd edition (ICHD-3) as the occurrence of headache on 15 or more days/month in a patient with a known history of primary headache disorder. […] The ICHD-3 diagnostic criteria in Table 1 is used to consider the diagnosis of MOH. […] It is important to consider the red flags for secondary headaches such as cerebral venous thrombosis and idiopathic intracranial hypertension, which can present in chronic headache with medication overuse when taking a patients history and performing the physical examination. […] The choice of which appropriate investigation to follow depends on the consideration of secondary headache diagnosis and the strength of suspicion. […] A detailed history is essential for headache evaluation, including the medication history. […] The onset of headache usually is gradual, and the nature of the headache is often typical, such as tension or migraine, and can be more frequent and intense. […] Patients with MOH usually report neck pain and headaches in the morning due to poor quality of sleep or overnight drug withdrawal.

• #2 Rebound Headaches: What They Are, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/6170-rebound-headaches

  Rebound headaches, formally known as medication overuse headaches, happen when you treat headaches with medication too often, causing more headaches, which can be even worse. […] Rebound headaches are a headache disorder that can happen when you treat headaches with medication too often. Theyre formally known as medication overuse headaches, but rebound headaches is the more commonly used term. […] A healthcare provider can diagnose rebound headaches using the International Classification of Headache Disorders criteria. Those criteria are: Headaches that happen at least 15 days per month related to a previously existing headache disorder. Regular use of medications to treat the headaches for at least three months. Another condition or diagnosis doesn’t better explain the headaches. […] There arent any tests that can diagnose rebound headaches.

• #2 Medication Overuse Headache | American Migraine Foundation

  https://americanmigrainefoundation.org/resource-library/medication-overuse-headache/

  People who have headaches, especially migraines, have a tendency to develop medication overuse headaches even if they are using the analgesics for other medical conditions. […] Medication overuse headaches occur frequently if opioid use is exceeded by more than ten days in a month. […] There are ongoing studies to establish the best way to treat medication overuse headache. Generally, a comprehensive management plan including a combination of medication, non-medication, behavioral and physical therapy interventions are usually necessary for treatment of medication overuse headaches along with the discontinuation of overused medication. […] It is important to know that when a medication that was being overused is discontinued, one may undergo a period where the headaches get worse before they get better.

• #2 A Descriptive Review of Medication-Overuse Headache: From Pathophysiology to the Comorbidities

  https://www.mdpi.com/2076-3425/13/10/1408

  Medication-overuse headache (MOH) is a secondary headache that is classified by the third edition of the International Classification of Headache Disorders as a group of headaches attributable to the administration or discontinuation of various substances. MOH occurs more than 15 days per month in patients with preexisting headaches. It occurs as a result of regular (at least 3 consecutive months) overuse (10 or 15 days, depending on the type of medication) of drugs used as acute or symptomatic headache therapy. […] The estimated global prevalence of medication-overuse headaches (MOHs) is about 3%. MOH is one of the most common secondary headaches, affecting approximately 80 million people worldwide. In tertiary care centers, 50% of headache patients suffer from MOH. This type of headache more commonly occurs in women (2:1 to 5:1) and typically occurs between ages 30 and 50 of life.

• #2 Medication Overuse Headache: Causes, Symptoms, and Treatments

  https://headacheaustralia.org.au/medication-overuse-headache/

  MOH can be subclassified by drug type. These classes include triptans, simple analgesics (pain relievers), opioids, or combination treatments. […] The evidence strongly suggests that MOH can make an already difficult situation difficult to treat or even worsen the condition. […] The challenge with this criteria is that it could easily fit the criteria for someone with chronic migraine. […] MOH is believed to only develop in primary headache patients who display frequent symptomatic medication use. […] The symptoms follow a similar process that involves sensory pathways which are chronically amplified and agitated and they become inherently sensitive environmental stimuli that we encounter in our daily life. […] There is also a great lack of awareness of MOH amongst both patients and health care professionals. Many people simply may not understand how acute medications for pain can lead to a worsening of their condition if not taken appropriately.

• #2 Medication-overuse headache: epidemiology, diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4110872/

  Data from a population-based longitudinal study suggested that those who used analgesics daily or weekly at baseline had a higher risk of developing chronic headache 11 years later. […] The procedures for detoxification vary substantially and include both in-patient (2 days to 2 weeks) and out-patient withdrawal. […] Regardless of the strategy, the main aims of the treatment are: Withdrawal of the overused drug(s), To provide the patient with pharmacological and nonpharmacological support, To prevent relapse. […] Clinical studies of treatment results from headache centres often have treatment success rates of around 70%. […] There is still some debate as to whether or not initially to detoxify MOH patients and whether prophylactic medication should be initiated immediately at withdrawal or after completed withdrawal therapy.

• #2 Medication-overuse headache: epidemiology, diagnosis and treatment

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4110872/

  Studies from clinical settings have reported a 20-40% relapse rate of detoxified patients within the first year after withdrawal. […] Some studies have found that most MOH patients do not know about the relationship between medication overuse and headache chronification. […] The improvement after withdrawal of the overused medication may potentially be augmented by a greater awareness by doctors, pharmacists and society in general regarding the dangers associated with inappropriate use of painkillers for headache. […] MOH is a worldwide public health problem. The treatment may be complex, but improvements seen in two out of three MOH patients after withdrawal suggest detoxification to be the treatment of first choice.

• #2 Medication Overuse Headache a Pain to Treat

  https://www.medscape.com/viewarticle/ehc-2023-medication-overuse-headache-pain-treat-2023a1000ukg

  The electronic headache diary has proven to be very useful, as it can aid accurate diagnosis by providing clear insights into a patient’s condition. […] „After diagnosing medication overuse or medication overuse headache, we advise our patients to discontinue the medication,” said Judith Pijpers of Leiden University Medical School, the Netherlands. […] The ability to accurately predict patients’ responses could pave the way for personalized treatments of medication overuse headache.

• #3 Medication-overuse headache: clinical profile and management strategies | Neurosciences Journal

  https://nsj.org.sa/content/28/1/13

  Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders 3rd edition (ICHD-3) as the occurrence of headache on 15 or more days/month in a patient with a known history of primary headache disorder. […] The ICHD-3 diagnostic criteria in Table 1 is used to consider the diagnosis of MOH. […] It is important to consider the red flags for secondary headaches such as cerebral venous thrombosis and idiopathic intracranial hypertension, which can present in chronic headache with medication overuse when taking a patients history and performing the physical examination. […] The choice of which appropriate investigation to follow depends on the consideration of secondary headache diagnosis and the strength of suspicion. […] A detailed history is essential for headache evaluation, including the medication history. […] The onset of headache usually is gradual, and the nature of the headache is often typical, such as tension or migraine, and can be more frequent and intense. […] Patients with MOH usually report neck pain and headaches in the morning due to poor quality of sleep or overnight drug withdrawal.

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