Materiały źródłowe

• #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. […] 8.2 Medication-overuse headache is an interaction between a therapeutic agent used excessively and a susceptible patient. […] 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. […] 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.

• #2 Headache from Medication Overuse | AMF

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

  The most effective method to treat MOH is discontinuation of the medication that is overused and a combination of pharmacological, non-pharmacological, behavioral and physical therapy interventions. […] Use of certain classes of acute medications such as opioids, barbiturate-containing analgesics and butalbital, aspirin and caffeine is associated with increased risk of chronic migraine. […] Medication-overuse headache is a secondary disorder caused by excessive use of acute medications. […] It is defined by the ICDH-3 diagnostic criteria as headache occurring on 15 or more days per month in a patient with a preexisting headache disorder who has been overusing one or more acute treatment drugs for symptomatic treatment of headache for three or more months, and those headaches cannot be accounted for by another diagnosis.

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

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

  As the name implies, chronic medication overuse is the most significant risk factor for the development of MOH, with each class of analgesics carrying a different risk profile. […] The risk from lowest to highest is: triptans/ergotamine, single analgesic agents (NSAIDs, acetaminophen), and combination analgesics containing opiates or barbiturates. […] Some studies suggest that NSAIDs may have a protective effect from MOH in patients with ten headache days or less per month. […] Of all headache types, migraine is the one most commonly associated with MOH and occurs in approximately 80% of patients. […] Patients with higher headache frequency at baseline are also at higher risk for MOH. […] It is unknown if the high headache frequency leads to more drug consumption and thus MOH or if patients with higher frequency attacks are more prone to MOH.

• #4 10 Things You Need to Know About Medication-Overuse Headache

  https://www.everydayhealth.com/migraine/things-you-need-to-know-about-medication-overuse-headache/

  Taking simple analgesics, including nonsteroidal anti-inflammatories (NSAIDs) a drug class that includes aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) on 15 or more days a month also constitutes overuse. […] The more headache days a person has, the more likely they are to transform to chronic migraine, says Tepper. […] Studies conducted both in the general population and in clinics show that people who have 10 to 14 headache days per month are 20 times more likely to develop daily headache than people who have fewer than five headache days per month, he says. […] The frequency of the headache days is actually a big risk for transforming, and the frequency of headaches is linked to how many times somebody reaches for an acute medication to treat, says Tepper, adding that although these are separate risks, they feed each other.

• #5 Headache from Medication Overuse | AMF

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

  People with higher frequency of headaches and greater disability have increased risk of developing chronic migraine. […] The diagnosis for medication-overuse headache is clinical, and a history of analgesic use more than two to three days per week in a patient with chronic daily headache is indicatory of this diagnosis. […] Discontinuation of overused medication is essential and the treatment of choice for MOH. […] It is important for the patient to know that when the medication overused is discontinued, they may undergo a period where their headaches will get worse. […] The physician will decide if the overused medication will be discontinued abruptly or if it needs to be tapered slowly. […] In certain circumstances, inpatient treatment may be considered so that medication can be tapered in a controlled environment, and prolonged intravenous medications can be used to break the headache cycle.

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

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

  Genetic factors may play a role. The risk of MOH is almost three times greater in those with a family history of MOH. […] There is also a great lack of awareness of MOH amongst both patients and health care professionals. […] MOH can occur from many different drug categories. […] Just having this discussion between the patient and doctor and discovering that the very thing that the patient is doing is likely making things significantly worse, is often very helpful and may be all that is needed.

• #7 Medication-Overuse Headache

  https://practicalneurology.com/diseases-diagnoses/headache-pain/medication-overuse-headache/30281/

  Medication-overuse headache (MOH) is a pattern of chronic daily headaches, in a patient with a pre-existing headache condition, caused by regular and excessive use of symptomatic and acute headache medications for 3 months or more. […] It is a secondary disorder in that it is caused by the very medications a patient uses to treat his or her headaches. […] Approximately 50% of patients with chronic headache have MOH and the overall prevalence is 1% to 2%. […] Risk factors for MOH include low socioeconomic status, higher body mass index, and anxiety and depression. […] Although virtually all drugs used for acute or symptomatic treatment of headache can cause MOH, and over-the-counter NSAIDs, acetaminophen, and combination analgesics are most frequently used, patients requiring secondary or tertiary care are more likely to be taking centrally acting drugs such as opioids, triptans, butalbital-containing combination pills, and over-the-counter combination products such as Excedrin (acetaminophen/aspirin/caffeine).

• #8

  https://link.springer.com/article/10.1007/s00415-021-10720-5

  Other risk factors associated with MOH include obesity, anxiety or depression, low educational level, smoking, chronic musculoskeletal or gastrointestinal diseases, and physical inactivity. […] The risk of developing MOH is increased in those with a family history of MOH or substance abuse. Since the risk of addictive behaviours in individuals is at least partly genetic, multiple studies have looked for associations between genetic polymorphisms and risk of MOH. […] Although there are significant associations between MOH features and some genetic polymorphisms, they have all come from candidate gene analyses in very small study populations. […] MOH involves elements of both chronic pain and substance misuse, both of which have been linked to suicide risk. […] Overall, the presence of MOH in chronic migraineurs was associated with increased risks of suicidal ideation (odds ratio 1.75, 95% CI 1.202.56) and suicide attempt (odds ratio 1.88, 95% CI 1.093.24).

• #9 Medication overuse headache | MedLink Neurology

  https://www.medlink.com/articles/medication-overuse-headache

  People using medication containing barbiturates or opiates had a two-fold higher risk of developing chronic headache than those using single analgesics or triptans. […] Obesity and metabolic syndrome have increasingly been recognized as an important risk factor for medication overuse headache. […] Depression and anxiety are more frequent in patients with medication overuse headache and seem to increase the risk of developing chronic headache by 50%. […] The pathophysiology of medication overuse headache still remains unclear. […] The number of animal studies has increased significantly. […] Genetic studies on medication overuse headache are ambiguous. […] There is growing evidence that central sensitization may play an important role in the pathophysiology of chronic headache. […] Psychological factors include the reinforcing properties of pain relief by drug consumption, a powerful component of positive conditioning. […] Withdrawal headache is an additional factor.

• #10

  https://link.springer.com/article/10.1007/s00415-021-10720-5

  Other risk factors associated with MOH include obesity, anxiety or depression, low educational level, smoking, chronic musculoskeletal or gastrointestinal diseases, and physical inactivity. […] The risk of developing MOH is increased in those with a family history of MOH or substance abuse. Since the risk of addictive behaviours in individuals is at least partly genetic, multiple studies have looked for associations between genetic polymorphisms and risk of MOH. […] Although there are significant associations between MOH features and some genetic polymorphisms, they have all come from candidate gene analyses in very small study populations. […] MOH involves elements of both chronic pain and substance misuse, both of which have been linked to suicide risk. […] Overall, the presence of MOH in chronic migraineurs was associated with increased risks of suicidal ideation (odds ratio 1.75, 95% CI 1.202.56) and suicide attempt (odds ratio 1.88, 95% CI 1.093.24).

• #11

  https://link.springer.com/article/10.1007/s00415-021-10720-5

  Other risk factors associated with MOH include obesity, anxiety or depression, low educational level, smoking, chronic musculoskeletal or gastrointestinal diseases, and physical inactivity. […] The risk of developing MOH is increased in those with a family history of MOH or substance abuse. Since the risk of addictive behaviours in individuals is at least partly genetic, multiple studies have looked for associations between genetic polymorphisms and risk of MOH. […] Although there are significant associations between MOH features and some genetic polymorphisms, they have all come from candidate gene analyses in very small study populations. […] MOH involves elements of both chronic pain and substance misuse, both of which have been linked to suicide risk. […] Overall, the presence of MOH in chronic migraineurs was associated with increased risks of suicidal ideation (odds ratio 1.75, 95% CI 1.202.56) and suicide attempt (odds ratio 1.88, 95% CI 1.093.24).

• #12

  https://link.springer.com/article/10.1007/s00415-021-10720-5

  Other risk factors associated with MOH include obesity, anxiety or depression, low educational level, smoking, chronic musculoskeletal or gastrointestinal diseases, and physical inactivity. […] The risk of developing MOH is increased in those with a family history of MOH or substance abuse. Since the risk of addictive behaviours in individuals is at least partly genetic, multiple studies have looked for associations between genetic polymorphisms and risk of MOH. […] Although there are significant associations between MOH features and some genetic polymorphisms, they have all come from candidate gene analyses in very small study populations. […] MOH involves elements of both chronic pain and substance misuse, both of which have been linked to suicide risk. […] Overall, the presence of MOH in chronic migraineurs was associated with increased risks of suicidal ideation (odds ratio 1.75, 95% CI 1.202.56) and suicide attempt (odds ratio 1.88, 95% CI 1.093.24).

• #13 Rebound Headache: What It Feels Like, Causes, Treatment

  https://www.verywellhealth.com/rebound-headache-8391723

  Factors associated with an increased risk of developing rebound headaches include: People assigned female at birth, smoking, physical inactivity, co-existing psychological conditions, like anxiety or depression, low socioeconomic status, family history of rebound headaches or substance abuse, high daily caffeine intake. […] Interestingly, genetic factors may also affect the likelihood of developing rebound headaches. […] Most acute headache medications can cause rebound headaches. […] The highest risk for rebound headaches is associated with opioids and butalbital-containing combination analgesics. […] Opioids and butalbital-containing combination analgesics can cause rebound headaches with 10 or more days of usage per month. […] The lowest risk for rebound headaches appears to occur with aspirin, Tylenol (acetaminophen), and nonsteroidal anti-inflammatory drugs (NSAIDs).

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

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

  As the name implies, chronic medication overuse is the most significant risk factor for the development of MOH, with each class of analgesics carrying a different risk profile. […] The risk from lowest to highest is: triptans/ergotamine, single analgesic agents (NSAIDs, acetaminophen), and combination analgesics containing opiates or barbiturates. […] Some studies suggest that NSAIDs may have a protective effect from MOH in patients with ten headache days or less per month. […] Of all headache types, migraine is the one most commonly associated with MOH and occurs in approximately 80% of patients. […] Patients with higher headache frequency at baseline are also at higher risk for MOH. […] It is unknown if the high headache frequency leads to more drug consumption and thus MOH or if patients with higher frequency attacks are more prone to MOH.

• #15 Medication overuse headaches | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/medication-overuse-headaches

  Painkillers made from opium or from human-made opium compounds have a high risk of causing medication overuse headaches. They include oxycodone (Oxycontin, Roxicodone, others) hydrocodone, tramadol (Conzip, Qdolo, others), and combined codeine and acetaminophen. Taking them 10 or more days a month can lead to medication overuse headaches.

• #16 Rebound Migraine: Causes, Treatment, Prevention

  https://www.healthline.com/health/migraine/rebound-migraine

  Most medications people use to relieve migraine pain can lead to MOH. But some medications have a higher risk than others. […] Opioids and medications that contain butalbital are most likely to cause MOH. Combination pain relievers, like acetaminophen/aspirin/caffeine (Excedrin), also present a very high risk. […] A 2020 study of MOH treatment strategies found that using preventive medications while tapering abortive treatments was most effective in reducing MOH.

• #17 Medication overuse headaches | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/medication-overuse-headaches?content_id=CON-20377066

  Medication overuse headaches are the result of the long-term use of medicines needed to treat headaches such as migraines. […] But people who take them more than a couple of days a week may get medication overuse headaches, also called rebound headaches. […] Experts don’t know exactly why medication overuse headaches happen. The risk of getting these headaches varies depending on the medicine. […] Most headache medicines can lead to medication overuse headaches, including: […] Pain relievers you can buy at the store that combine caffeine, aspirin and acetaminophen (Excedrin) have a moderate risk of causing medication overuse headaches. […] Medicines with butalbital have a high risk of causing medication overuse headaches. It’s best not to take them to treat headaches. […] Triptans (Imitrex, Zomig, others) used to treat migraine have a high risk of medication overuse headaches.

• #18 Rebound Headaches: Causes, Symptoms, and Treatments | SELF

  https://www.self.com/story/understanding-rebound-headaches

  Over-the-counter (OTC) pain relievers that combine caffeine, aspirin, and acetaminophen (Excedrin, others) are common culprits. […] Butalbital-containing compounds have an especially high risk of causing rebound headaches, so it’s best not to take them to treat headaches. […] Various migraine medications have been linked with rebound headaches, including triptans (Imitrex, Zomig, others) and certain ergotssuch as ergotamine (Ergomar, others). […] These medications have a moderate risk of causing medication-overuse headaches. […] Painkillers derived from opium or from synthetic opium compounds include combinations of codeine and acetaminophen (Tylenol with Codeine No. 3 and No. 4, others). […] These medications have a high risk of causing rebound headaches.

• #19 Medication overuse headaches | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/medication-overuse-headaches?content_id=CON-20377066

  Medication overuse headaches are the result of the long-term use of medicines needed to treat headaches such as migraines. […] But people who take them more than a couple of days a week may get medication overuse headaches, also called rebound headaches. […] Experts don’t know exactly why medication overuse headaches happen. The risk of getting these headaches varies depending on the medicine. […] Most headache medicines can lead to medication overuse headaches, including: […] Pain relievers you can buy at the store that combine caffeine, aspirin and acetaminophen (Excedrin) have a moderate risk of causing medication overuse headaches. […] Medicines with butalbital have a high risk of causing medication overuse headaches. It’s best not to take them to treat headaches. […] Triptans (Imitrex, Zomig, others) used to treat migraine have a high risk of medication overuse headaches.

• #20 Medication Overuse (Rebound) Headache | Migraine.comShare to Facebookprint pageBookmark for latercaret iconFollow us on facebookFollow us on instagramFollow us on facebookFollow us on linkedincaret icon

  https://migraine.com/headache-types/medication-overuse-rebound

  If you suffer from migraine, you may have heard of the term rebound headache, also known as medication overuse headache. This is a type of headache that has been linked to excessive use of some acute medicines. These medicines may be prescription or over-the-counter (OTC) drugs taken to treat head pain, as well as migraine. However, if you take these medications more than a few days a week, they can cause medication overuse headache. […] Medication overuse is defined by how much acute medication you take per month. Acute medication is a medicine used to stop a migraine, as opposed to preventing one. These medicines and ingredients may cause medication overuse headaches: […] Simple analgesics: Products with 1 ingredient, like aspirin, Tylenol (acetaminophen), ibuprofen, or naproxen, can cause medication overuse headache if you take more than the recommended daily dosage or if you use them for 15 or more days per month

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

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

  As the name implies, chronic medication overuse is the most significant risk factor for the development of MOH, with each class of analgesics carrying a different risk profile. […] The risk from lowest to highest is: triptans/ergotamine, single analgesic agents (NSAIDs, acetaminophen), and combination analgesics containing opiates or barbiturates. […] Some studies suggest that NSAIDs may have a protective effect from MOH in patients with ten headache days or less per month. […] Of all headache types, migraine is the one most commonly associated with MOH and occurs in approximately 80% of patients. […] Patients with higher headache frequency at baseline are also at higher risk for MOH. […] It is unknown if the high headache frequency leads to more drug consumption and thus MOH or if patients with higher frequency attacks are more prone to MOH.

• #22 Medication Overuse Headache – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/headaches/medication-overuse-headache

  A medication overuse (rebound) headache occurs when people who take too many headache medications have a headache for more than 15 days a month for more than 3 months. […] Medication overuse headache develops most often in people who have migraines or a tension-type headache. […] The most common causes of medication overuse headache are overuse of the following: Opioids, Nonsteroidal anti-inflammatory drugs (NSAIDs), Pain relievers (analgesics) that contain butalbital (a barbiturate), Aspirin or acetaminophen taken with caffeine, Ergotamine, Triptans (medications that prevent and treat migraines). […] An overly sensitive nervous system is thought to cause medication overuse headache. That is, the nerve cells in the brain that trigger pain are too easily stimulated. […] Substance dependence is more common among people with medication overuse headaches. They may also have a genetic predisposition to develop medication overuse headache.

• #23 Rebound headaches: Causes, treatment, prevention

  https://www.medicalnewstoday.com/articles/rebound-headaches

  However, it is unclear if the connection is causal or another effect of rebound headaches. […] The most commonly discussed medications are: ergotamine, used on 10 or more days per month; triptan, used 10 or more days per month; acetylsalicylic acid, used 15 or more days per month; non-steroidal anti-inflammatory drugs, used 15 or more days per month; acetaminophen/paracetamol, used 15 or more days per month; opioids, used 10 or more days per month. […] Therefore, withdrawal from these medications is the usual treatment for medication overuse headaches. […] Rebound headaches will often resolve to normal headaches within two months of stopping the overused medication. […] The less frequently a person uses painkillers to treat headaches as they occur, the less likely they are to develop rebound headaches. […] Excessive use of medication to treat headaches can cause rebound headaches. […] Rebound headaches are difficult to successfully treat as a high percentage of people who receive treatment go on to relapse and therefore develop rebound headaches once more.

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

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

  The pathophysiology of MOH is not well understood, but studies have demonstrated that central sensitization likely plays a major role. […] The condition exhibits both functional and structural changes in the central nervous system (CNS), particularly the hippocampal periaqueductal gray area, posterior cingulate cortex thalamus, cerebellum, and orbitofrontal cortex (OFC), and the mesocorticolimbic reward system. […] Some studies have theorized a potential genetic risk as to the etiology of the development of MOH. […] The thinking is that the insertion/deletion polymorphism in the gene that encodes an angiotensin-converting enzyme (ACE) increases an individuals susceptibility to MOH. […] All of these lead to disturbances in the normal brain pathway neurotransmitters making patients more susceptible to dependence, behavioral disorders, substance abuse, pain disorders, and several neuropsychiatric disorders.

• #25 Medication Overuse Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470171/

  The most common group of patients with medication overuse headaches are those with chronic migraine, who account for about two-thirds of patients with medication overuse headaches. […] Patients with headaches respond to acute medications differently. The use of an inappropriate headache abortive medication or less effective medication can increase the frequency of medication consumption and lead to medication overuse headaches. […] The exact mechanism of medication overuse headaches is unclear. However, it is hypothesized that medication overuse headaches result from the depletion of 5-HT due to the overuse of headache-abortive medications. […] Other studies have shown structural and functional brain changes in patients with medication overuse headaches. […] Medication overuse headaches occur relatively commonly in patients with chronic migraines, with about 32% of individuals in this group experiencing medication overuse headaches.

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

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

  The pathophysiology of MOH is not well understood, but studies have demonstrated that central sensitization likely plays a major role. […] The condition exhibits both functional and structural changes in the central nervous system (CNS), particularly the hippocampal periaqueductal gray area, posterior cingulate cortex thalamus, cerebellum, and orbitofrontal cortex (OFC), and the mesocorticolimbic reward system. […] Some studies have theorized a potential genetic risk as to the etiology of the development of MOH. […] The thinking is that the insertion/deletion polymorphism in the gene that encodes an angiotensin-converting enzyme (ACE) increases an individuals susceptibility to MOH. […] All of these lead to disturbances in the normal brain pathway neurotransmitters making patients more susceptible to dependence, behavioral disorders, substance abuse, pain disorders, and several neuropsychiatric disorders.

• #27 Medication Overuse Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470171/

  The most common group of patients with medication overuse headaches are those with chronic migraine, who account for about two-thirds of patients with medication overuse headaches. […] Patients with headaches respond to acute medications differently. The use of an inappropriate headache abortive medication or less effective medication can increase the frequency of medication consumption and lead to medication overuse headaches. […] The exact mechanism of medication overuse headaches is unclear. However, it is hypothesized that medication overuse headaches result from the depletion of 5-HT due to the overuse of headache-abortive medications. […] Other studies have shown structural and functional brain changes in patients with medication overuse headaches. […] Medication overuse headaches occur relatively commonly in patients with chronic migraines, with about 32% of individuals in this group experiencing medication overuse headaches.

• #28 Medication-Overuse Headache

  https://practicalneurology.com/diseases-diagnoses/headache-pain/medication-overuse-headache/30281/

  MOH, by definition, occurs only in individuals who already have a headache disorder. […] It is unclear whether MOH is a consequence of living with chronic daily headache or the reverse, but it is clear that withdrawal of the overused drug(s) bring(s) relief to the majority of patients, suggesting a causative role for the medications. […] However, not everyone with medication overuse develops MOH. […] As pre-existing headaches seem to be required for MOH to develop (daily use of these drugs for other conditions does not cause MOH), there seems to be a relationship between the pre-existing headache mechanism or pain pathway and MOH. […] MOH produces central sensitization with structural and functional changes in the trigeminal nucleus caudalis, resulting in a decrease in the pain threshold and an increase in receptive fields.

• #29 Medication-Overuse Headache

  https://practicalneurology.com/articles/2018-feb/medication-overuse-headache

  MOH, by definition, occurs only in individuals who already have a headache disorder. It does not occur de novo without history of headache. […] It is unclear whether MOH is a consequence of living with chronic daily headache or the reverse, but it is clear that withdrawal of the overused drug(s) bring(s) relief to the majority of patients, suggesting a causative role for the medications. […] Alteration of cortical activity, central sensitization of the nociceptive trigeminal system, and changes in serotonin and dopamine expression and cannabinoid and calcitonin gene-related peptide receptors have all been considered as potential pathways for MOH. […] MOH produces central sensitization with structural and functional changes in the trigeminal nucleus caudalis, resulting in a decrease in the pain threshold and an increase in receptive fields.

• #30 Understanding the pathophysiology of medication overuse headache | MDedge

  https://www.mdedge.com/migraine-icymi/article/242061/understanding-pathophysiology-medication-overuse-headache

  This suggests a cause-and-effect relationship, indicating that medication use causes transformation to medication overuse headache in patients with preexisting headache disorders—and is not the result of it. […] The higher prevalence of psychiatric comorbidities, including depression, anxiety disorders, sleep disturbance, and non-cephalic body pain, suggest that they may either be causative or just comorbid. […] For medication overuse headache to develop, clinicians should see an underlying primary headache worsen with frequent acute care medication use as well as peripheral trigeminal nociceptor activation. […] Research shows that in individuals who experience medication overuse headache, platelet serotonin is decreased and the density of serotonin receptors on platelets is increased, implying suppressed serotonin function.

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

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

  The pathophysiology of MOH is not well understood, but studies have demonstrated that central sensitization likely plays a major role. […] The condition exhibits both functional and structural changes in the central nervous system (CNS), particularly the hippocampal periaqueductal gray area, posterior cingulate cortex thalamus, cerebellum, and orbitofrontal cortex (OFC), and the mesocorticolimbic reward system. […] Some studies have theorized a potential genetic risk as to the etiology of the development of MOH. […] The thinking is that the insertion/deletion polymorphism in the gene that encodes an angiotensin-converting enzyme (ACE) increases an individuals susceptibility to MOH. […] All of these lead to disturbances in the normal brain pathway neurotransmitters making patients more susceptible to dependence, behavioral disorders, substance abuse, pain disorders, and several neuropsychiatric disorders.

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

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

  The pathophysiology of MOH is not well understood, but studies have demonstrated that central sensitization likely plays a major role. […] The condition exhibits both functional and structural changes in the central nervous system (CNS), particularly the hippocampal periaqueductal gray area, posterior cingulate cortex thalamus, cerebellum, and orbitofrontal cortex (OFC), and the mesocorticolimbic reward system. […] Some studies have theorized a potential genetic risk as to the etiology of the development of MOH. […] The thinking is that the insertion/deletion polymorphism in the gene that encodes an angiotensin-converting enzyme (ACE) increases an individuals susceptibility to MOH. […] All of these lead to disturbances in the normal brain pathway neurotransmitters making patients more susceptible to dependence, behavioral disorders, substance abuse, pain disorders, and several neuropsychiatric disorders.

• #33 Medication overuse headache | MedLink Neurology

  https://www.medlink.com/articles/medication-overuse-headache

  People using medication containing barbiturates or opiates had a two-fold higher risk of developing chronic headache than those using single analgesics or triptans. […] Obesity and metabolic syndrome have increasingly been recognized as an important risk factor for medication overuse headache. […] Depression and anxiety are more frequent in patients with medication overuse headache and seem to increase the risk of developing chronic headache by 50%. […] The pathophysiology of medication overuse headache still remains unclear. […] The number of animal studies has increased significantly. […] Genetic studies on medication overuse headache are ambiguous. […] There is growing evidence that central sensitization may play an important role in the pathophysiology of chronic headache. […] Psychological factors include the reinforcing properties of pain relief by drug consumption, a powerful component of positive conditioning. […] Withdrawal headache is an additional factor.

• #34 Rebound Migraine: Causes, Treatment, Prevention

  https://www.healthline.com/health/migraine/rebound-migraine

  What causes medication overuse headaches? […] One explanation for the higher rates is that people with migraine typically take medications linked to MOH. Taking these medications frequently increases your risk of MOH. […] Doctors dont know exactly why people with these risk factors experience MOH. In fact, researchers arent entirely sure why medication overuse leads to MOH, but some theories exist. […] One theory is that frequent use of some medications can cause changes in the brain, leading to greater sensitivity to headaches and higher sensations of pain. These changes often depend on the specific medications youre taking. […] Researchers have recently targeted the calcitonin gene-related peptide (CGRP) system as a possible cause of MOH. […] Researchers theorize that people with migraine take medications that suppress the release or absorption of chemicals that can cause migraine episodes. As a result, their bodies compensate by trying to make more of these receptors. The extra receptors make a person even more sensitive to headaches and headache pain.

• #35 Medication Overuse Headache | Peter O’Donnell Jr. Brain Institute | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/medication-overuse-headache/

  Medication overuse headache (MOH), sometimes called a rebound headache or transformed migraine, occurs when headache treatments are used too frequently. Overusing treatments for headache symptoms can worsen headaches. A persons headaches also might become harder to treat, more resistant to preventive medications, and more chronic. […] MOHs can complicate almost any type of headache, although they most frequently occur in patients with migraines. MOHs usually develop unintentionally. A headache sufferer might reach for his or her medication bottle at the slightest twinge of pain or use pain medications pre-emptively in situations known to trigger a headache. Over time, the receptors in the brain change in response to chronic exposure to medications, and it requires more and more medication to produce the same effect. […] Almost any pain medication can lead to MOH. Opioids and narcotics are extremely problematic in that they lead to MOH as well as physical and psychological dependence.

• #36 Medication overuse headaches

  https://johnsonmemorial.org/jmh-health/disease-conditions/con-20377066

  Medication overuse headaches also known as rebound headaches are caused by the long-term use of medicines to treat headaches such as migraines. […] Experts don’t yet know exactly why medication overuse headaches occur. The risk of developing them varies depending on the medicine. But most headache medicines have the potential to lead to medication overuse headaches, including: […] Daily doses of caffeine also may fuel medication overuse headaches. Caffeine may come from coffee, soda, pain relievers and other products. […] Risk factors for developing medication overuse headaches include: […] To help prevent medication overuse headaches: […] To break the cycle of medication overuse headaches, you’ll need to restrict pain medicine. […] When you stop your medicine, expect headaches to get worse before they get better. You can develop a dependence on some medicines that result in medication overuse headaches. […] Preventive medicines may help you break the cycle of medication overuse headaches. […] Injections of onabotulinumtoxinA (Botox) may help reduce the number of headaches you have each month.

• #37 Understanding the pathophysiology of medication overuse headache | MDedge

  https://www.mdedge.com/migraine-icymi/article/242061/understanding-pathophysiology-medication-overuse-headache

  They concluded that altered serotonin levels and incoming trigeminal nociceptive input are important components of the pathogenesis of medication overuse headache. […] Researchers concluded that acute migraine medications may promote medication overuse headache in susceptible headache sufferers via CGRP-driven mechanisms. […] This suggests that individuals with medication overuse headache might have a brain trait that predisposes them to overuse medication. […] They concluded that individuals with medication overuse headache had a distinct concentration of myo-inositol in the anterior cingulate cortices that may be a result of medication overuse and might lead to the development of medication overuse headache. […] An understanding of these very complex pathophysiological findings in medication overuse headache serves as a foundation for neurologists and headache specialists.

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

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

  When this happens, pain returns as each dose of medicine wears off and even if the medicine is stopped, withdrawal symptoms are common. The need to relieve these withdrawal symptoms, and still treat the pain, leads to further use of painkillers and a cycle of medicine overuse starts. After a while the painkillers stop helping the original pain and start causing more pain. […] People with migraine will usually experience episodic attacks consisting of several symptoms (e.g. pain, nausea, vomiting, sensitivity to light and sound), but they go back to being symptom-free between attacks. In medication-overuse headache, a dull constant headache is present on most days or a part of every day. Eventually a pattern develops with headaches on most days and migraine attacks on top of that background pain. The overuse of painkillers may also reduce the effectiveness of preventive migraine medications.

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

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

  When this happens, pain returns as each dose of medicine wears off and even if the medicine is stopped, withdrawal symptoms are common. The need to relieve these withdrawal symptoms, and still treat the pain, leads to further use of painkillers and a cycle of medicine overuse starts. After a while the painkillers stop helping the original pain and start causing more pain. […] People with migraine will usually experience episodic attacks consisting of several symptoms (e.g. pain, nausea, vomiting, sensitivity to light and sound), but they go back to being symptom-free between attacks. In medication-overuse headache, a dull constant headache is present on most days or a part of every day. Eventually a pattern develops with headaches on most days and migraine attacks on top of that background pain. The overuse of painkillers may also reduce the effectiveness of preventive migraine medications.

• #40

  https://link.springer.com/article/10.1007/s00415-021-10720-5

  Medication-overuse headache (MOH) has a prevalence of approximately 1% and is among the top 20 causes of disability worldwide, leading to considerable medical, social, and economic costs. It is defined in the International Classification of Headache Disorders (ICHD-3) as a headache occurring on at least 15 days per month in someone with a pre-existing headache disorder and developing as a result of regular overuse of one or more acute/symptomatic headache treatments for at least 3 months. Overuse is defined as at least 10 days per month for triptans, opioids and ergotamine, or at least 15 days per month for paracetamol, aspirin, and non-steroidal anti-inflammatory drugs. The frequency of acute medication use seems more important in the development of MOH than the cumulative dosage taken. MOH most often develops in those with underlying migraine or tension-type headache, but it can occur with other primary headache disorders such as cluster headache or new daily persistent headache.

• #41 Medication Overuse Headache: Causes, Consequences, and Treatment | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4614-3375-0_28

  All primary headache subtypes (migraine, tension-type headache, cluster headache) may become complicated by medication overuse headache (MOH). MOH has developed into the third most common type of headache after tension-type headache and migraine. The prevalence reaches approximately 1% of the worlds population and shows an increasing trend. MOH is a condition in which headaches become increasingly frequent as a patient begins to use more and more acute headache medications. The initial headache frequency is one of the factors that may play a role in the development of MOH. However, the reasons why some patients overuse acute treatments of headaches whereas others do not are not clearly understood. MOH might be prompted and sustained by some psychological states and behavioral disorders, including fear of headache, anticipatory anxiety of attacks, and psychological drug dependence. A range of behaviors presumed to be related to excessive medications are being increasingly recognized in MOH disease. These behaviors are linked by their reward-based and repetitive natures. Whether these behaviors are simply related to medications interacting with an underlying individual vulnerability or whether the primary pathological features of MOH play a role is not known. Neurobiological mechanisms underlying drug dependence and reward system (i.e. endocannabinoids, dopamine, orexins) might also be involved in MOH. The study of these neurobiological mechanisms and behaviors might allow not only a greater insight into the pathophysiology of MOH but also an improved clinical management of this disorder.

• #42 Medication Overuse Headache: Causes, Consequences, and Treatment | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4614-3375-0_28

  All primary headache subtypes (migraine, tension-type headache, cluster headache) may become complicated by medication overuse headache (MOH). MOH has developed into the third most common type of headache after tension-type headache and migraine. The prevalence reaches approximately 1% of the worlds population and shows an increasing trend. MOH is a condition in which headaches become increasingly frequent as a patient begins to use more and more acute headache medications. The initial headache frequency is one of the factors that may play a role in the development of MOH. However, the reasons why some patients overuse acute treatments of headaches whereas others do not are not clearly understood. MOH might be prompted and sustained by some psychological states and behavioral disorders, including fear of headache, anticipatory anxiety of attacks, and psychological drug dependence. A range of behaviors presumed to be related to excessive medications are being increasingly recognized in MOH disease. These behaviors are linked by their reward-based and repetitive natures. Whether these behaviors are simply related to medications interacting with an underlying individual vulnerability or whether the primary pathological features of MOH play a role is not known. Neurobiological mechanisms underlying drug dependence and reward system (i.e. endocannabinoids, dopamine, orexins) might also be involved in MOH. The study of these neurobiological mechanisms and behaviors might allow not only a greater insight into the pathophysiology of MOH but also an improved clinical management of this disorder.

• #43 Medication Overuse Headache: Causes, Consequences, and Treatment | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4614-3375-0_28

  All primary headache subtypes (migraine, tension-type headache, cluster headache) may become complicated by medication overuse headache (MOH). MOH has developed into the third most common type of headache after tension-type headache and migraine. The prevalence reaches approximately 1% of the worlds population and shows an increasing trend. MOH is a condition in which headaches become increasingly frequent as a patient begins to use more and more acute headache medications. The initial headache frequency is one of the factors that may play a role in the development of MOH. However, the reasons why some patients overuse acute treatments of headaches whereas others do not are not clearly understood. MOH might be prompted and sustained by some psychological states and behavioral disorders, including fear of headache, anticipatory anxiety of attacks, and psychological drug dependence. A range of behaviors presumed to be related to excessive medications are being increasingly recognized in MOH disease. These behaviors are linked by their reward-based and repetitive natures. Whether these behaviors are simply related to medications interacting with an underlying individual vulnerability or whether the primary pathological features of MOH play a role is not known. Neurobiological mechanisms underlying drug dependence and reward system (i.e. endocannabinoids, dopamine, orexins) might also be involved in MOH. The study of these neurobiological mechanisms and behaviors might allow not only a greater insight into the pathophysiology of MOH but also an improved clinical management of this disorder.

• #44 Understanding the pathophysiology of medication overuse headache | MDedge

  https://www.mdedge.com/migraine-icymi/article/242061/understanding-pathophysiology-medication-overuse-headache

  This suggests a cause-and-effect relationship, indicating that medication use causes transformation to medication overuse headache in patients with preexisting headache disorders—and is not the result of it. […] The higher prevalence of psychiatric comorbidities, including depression, anxiety disorders, sleep disturbance, and non-cephalic body pain, suggest that they may either be causative or just comorbid. […] For medication overuse headache to develop, clinicians should see an underlying primary headache worsen with frequent acute care medication use as well as peripheral trigeminal nociceptor activation. […] Research shows that in individuals who experience medication overuse headache, platelet serotonin is decreased and the density of serotonin receptors on platelets is increased, implying suppressed serotonin function.

• #45 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. […] 8.2 Medication-overuse headache is an interaction between a therapeutic agent used excessively and a susceptible patient. […] 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. […] 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.

• #46 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. […] 8.2 Medication-overuse headache is an interaction between a therapeutic agent used excessively and a susceptible patient. […] 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. […] 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.

• #47 Medication Overuse Headache: Causes, Consequences, and Treatment | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4614-3375-0_28

  All primary headache subtypes (migraine, tension-type headache, cluster headache) may become complicated by medication overuse headache (MOH). MOH has developed into the third most common type of headache after tension-type headache and migraine. The prevalence reaches approximately 1% of the worlds population and shows an increasing trend. MOH is a condition in which headaches become increasingly frequent as a patient begins to use more and more acute headache medications. The initial headache frequency is one of the factors that may play a role in the development of MOH. However, the reasons why some patients overuse acute treatments of headaches whereas others do not are not clearly understood. MOH might be prompted and sustained by some psychological states and behavioral disorders, including fear of headache, anticipatory anxiety of attacks, and psychological drug dependence. A range of behaviors presumed to be related to excessive medications are being increasingly recognized in MOH disease. These behaviors are linked by their reward-based and repetitive natures. Whether these behaviors are simply related to medications interacting with an underlying individual vulnerability or whether the primary pathological features of MOH play a role is not known. Neurobiological mechanisms underlying drug dependence and reward system (i.e. endocannabinoids, dopamine, orexins) might also be involved in MOH. The study of these neurobiological mechanisms and behaviors might allow not only a greater insight into the pathophysiology of MOH but also an improved clinical management of this disorder.

• #48 Medication Overuse Headache | Peter O’Donnell Jr. Brain Institute | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/medication-overuse-headache/

  Medication overuse headache (MOH), sometimes called a rebound headache or transformed migraine, occurs when headache treatments are used too frequently. Overusing treatments for headache symptoms can worsen headaches. A persons headaches also might become harder to treat, more resistant to preventive medications, and more chronic. […] MOHs can complicate almost any type of headache, although they most frequently occur in patients with migraines. MOHs usually develop unintentionally. A headache sufferer might reach for his or her medication bottle at the slightest twinge of pain or use pain medications pre-emptively in situations known to trigger a headache. Over time, the receptors in the brain change in response to chronic exposure to medications, and it requires more and more medication to produce the same effect. […] Almost any pain medication can lead to MOH. Opioids and narcotics are extremely problematic in that they lead to MOH as well as physical and psychological dependence.

• #49 Medication Overuse Headache | Peter O’Donnell Jr. Brain Institute | Condition | UT Southwestern Medical Center

  https://utswmed.org/conditions-treatments/medication-overuse-headache/

  Medication overuse headache (MOH), sometimes called a rebound headache or transformed migraine, occurs when headache treatments are used too frequently. Overusing treatments for headache symptoms can worsen headaches. A persons headaches also might become harder to treat, more resistant to preventive medications, and more chronic. […] MOHs can complicate almost any type of headache, although they most frequently occur in patients with migraines. MOHs usually develop unintentionally. A headache sufferer might reach for his or her medication bottle at the slightest twinge of pain or use pain medications pre-emptively in situations known to trigger a headache. Over time, the receptors in the brain change in response to chronic exposure to medications, and it requires more and more medication to produce the same effect. […] Almost any pain medication can lead to MOH. Opioids and narcotics are extremely problematic in that they lead to MOH as well as physical and psychological dependence.

• #50 Medication-Overuse Headache

  https://practicalneurology.com/diseases-diagnoses/headache-pain/medication-overuse-headache/30281/

  Left untreated, MOH contributes to the development of a chronic and refractory character to headaches, which become less responsive to both preventive and acute medications. […] Patients with MOH are also at risk of other, non-headache-related complications secondary to the frequent use of acute medications, such as gastrointestinal bleeding, renal and liver failure, and addiction and dependence.

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

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

  When this happens, pain returns as each dose of medicine wears off and even if the medicine is stopped, withdrawal symptoms are common. The need to relieve these withdrawal symptoms, and still treat the pain, leads to further use of painkillers and a cycle of medicine overuse starts. After a while the painkillers stop helping the original pain and start causing more pain. […] People with migraine will usually experience episodic attacks consisting of several symptoms (e.g. pain, nausea, vomiting, sensitivity to light and sound), but they go back to being symptom-free between attacks. In medication-overuse headache, a dull constant headache is present on most days or a part of every day. Eventually a pattern develops with headaches on most days and migraine attacks on top of that background pain. The overuse of painkillers may also reduce the effectiveness of preventive migraine medications.

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

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

  When this happens, pain returns as each dose of medicine wears off and even if the medicine is stopped, withdrawal symptoms are common. The need to relieve these withdrawal symptoms, and still treat the pain, leads to further use of painkillers and a cycle of medicine overuse starts. After a while the painkillers stop helping the original pain and start causing more pain. […] People with migraine will usually experience episodic attacks consisting of several symptoms (e.g. pain, nausea, vomiting, sensitivity to light and sound), but they go back to being symptom-free between attacks. In medication-overuse headache, a dull constant headache is present on most days or a part of every day. Eventually a pattern develops with headaches on most days and migraine attacks on top of that background pain. The overuse of painkillers may also reduce the effectiveness of preventive migraine medications.

• #53 Medication Overuse Headache | American Migraine Foundation

  https://americanmigrainefoundation.org/resource-library/medication-overuse-headache-3/

  During a migraine attack, popping a pill that cuts through the pain can feel like a lifesaver. But overusing medications can cause a new type of headache and reduce the effectiveness of treatment […] Medication overuse headache can be caused by prescription or over-the-counter medicines. It has three key effects: it makes migraine medication less effective over time; it causes dull, persistent head pain between migraine attacks; and it can cause the disease to progress, leading to more frequent migraine attacks in the long term. Those most at risk of developing medication overuse headache are people with migraine who have 10 or more headache days per month and treat each attack with medication […] Medication overuse headache can often cause migraine to irreversibly progress from episodic to chronic, so prevention is important. According to Friedman, there are warning signs people with migraine should watch for.

• #54 Headache from Medication Overuse | AMF

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

  Medication-overuse headache (MOH) is a chronic daily headache and a secondary disorder in which acute medications used excessively causes headache in a headache-prone patient. […] MOH is clinical diagnosis and a history of analgesic use more than two to three days per week in a patient with chronic daily headache is indicatory of this diagnosis. […] MOH most commonly occurs in people with primary headache disorders like migraine, cluster, or tension-type headaches using less effective or nonspecific medications resulting in inadequate treatment response and redosing. […] MOH development is linked to baseline frequency of headache days per month, acute medication class ingested, frequency of acute medications ingested, and other risk factors. […] Medication overuse headache has been found to render headaches refractory to both pharmacological and non-pharmacological prophylactic medications, and also reduces the efficacy of acute abortive therapy for migraines.

• #55 Headache from Medication Overuse | AMF

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

  Medication-overuse headache (MOH) is a chronic daily headache and a secondary disorder in which acute medications used excessively causes headache in a headache-prone patient. […] MOH is clinical diagnosis and a history of analgesic use more than two to three days per week in a patient with chronic daily headache is indicatory of this diagnosis. […] MOH most commonly occurs in people with primary headache disorders like migraine, cluster, or tension-type headaches using less effective or nonspecific medications resulting in inadequate treatment response and redosing. […] MOH development is linked to baseline frequency of headache days per month, acute medication class ingested, frequency of acute medications ingested, and other risk factors. […] Medication overuse headache has been found to render headaches refractory to both pharmacological and non-pharmacological prophylactic medications, and also reduces the efficacy of acute abortive therapy for migraines.

• #56 Medication-Overuse Headache

  https://practicalneurology.com/diseases-diagnoses/headache-pain/medication-overuse-headache/30281/

  Left untreated, MOH contributes to the development of a chronic and refractory character to headaches, which become less responsive to both preventive and acute medications. […] Patients with MOH are also at risk of other, non-headache-related complications secondary to the frequent use of acute medications, such as gastrointestinal bleeding, renal and liver failure, and addiction and dependence.

• #57 Medication-Overuse Headache

  https://practicalneurology.com/articles/2018-feb/medication-overuse-headache

  Left untreated, MOH contributes to the development of a chronic and refractory character to headaches, which become less responsive to both preventive and acute medications. This leads to profound disability and poor quality of life. […] With treatment, 72% of patients have at least 50% fewer headaches within 1 to 6 months.

• #58 Medication-Overuse Headache

  https://practicalneurology.com/diseases-diagnoses/headache-pain/medication-overuse-headache/30281/

  Left untreated, MOH contributes to the development of a chronic and refractory character to headaches, which become less responsive to both preventive and acute medications. […] Patients with MOH are also at risk of other, non-headache-related complications secondary to the frequent use of acute medications, such as gastrointestinal bleeding, renal and liver failure, and addiction and dependence.

• #59 Medication-Overuse Headache

  https://practicalneurology.com/diseases-diagnoses/headache-pain/medication-overuse-headache/30281/

  Left untreated, MOH contributes to the development of a chronic and refractory character to headaches, which become less responsive to both preventive and acute medications. […] Patients with MOH are also at risk of other, non-headache-related complications secondary to the frequent use of acute medications, such as gastrointestinal bleeding, renal and liver failure, and addiction and dependence.

• #60

  https://link.springer.com/article/10.1007/s00415-021-10720-5

  Other risk factors associated with MOH include obesity, anxiety or depression, low educational level, smoking, chronic musculoskeletal or gastrointestinal diseases, and physical inactivity. […] The risk of developing MOH is increased in those with a family history of MOH or substance abuse. Since the risk of addictive behaviours in individuals is at least partly genetic, multiple studies have looked for associations between genetic polymorphisms and risk of MOH. […] Although there are significant associations between MOH features and some genetic polymorphisms, they have all come from candidate gene analyses in very small study populations. […] MOH involves elements of both chronic pain and substance misuse, both of which have been linked to suicide risk. […] Overall, the presence of MOH in chronic migraineurs was associated with increased risks of suicidal ideation (odds ratio 1.75, 95% CI 1.202.56) and suicide attempt (odds ratio 1.88, 95% CI 1.093.24).

• #61 Medication Overuse Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470171/

  According to the International Classification of Headache Disorders, 3rd edition, a medication overuse headache is a secondary chronic headache disorder. This condition is defined as headaches occurring for 15 or more days per month for 3 or more months in patients taking acute headache treatments too frequently. Medication overuse headaches are believed to occur when medications intended to relieve headaches are consumed frequently. Causal agents are varied and can include agents such as nonsteroidal anti-inflammatory drugs, triptans, ergot derivatives, and opioids, although any analgesic can potentially trigger the medication overuse headache. […] Medication overuse headaches are believed to occur when patients frequently use acute headache medications at the following rates15 or more days per month for simple analgesics, such as acetaminophen and NSAIDs, and 10 or more days per month for ergotamine, triptans, opioids, or combination analgesics, such as butalbital, acetaminophen, or caffeine.

• #62 Medication Overuse Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470171/

  According to the International Classification of Headache Disorders, 3rd edition, a medication overuse headache is a secondary chronic headache disorder. This condition is defined as headaches occurring for 15 or more days per month for 3 or more months in patients taking acute headache treatments too frequently. Medication overuse headaches are believed to occur when medications intended to relieve headaches are consumed frequently. Causal agents are varied and can include agents such as nonsteroidal anti-inflammatory drugs, triptans, ergot derivatives, and opioids, although any analgesic can potentially trigger the medication overuse headache. […] Medication overuse headaches are believed to occur when patients frequently use acute headache medications at the following rates15 or more days per month for simple analgesics, such as acetaminophen and NSAIDs, and 10 or more days per month for ergotamine, triptans, opioids, or combination analgesics, such as butalbital, acetaminophen, or caffeine.

• #63 Medication Overuse Headache – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470171/

  According to the International Classification of Headache Disorders, 3rd edition, a medication overuse headache is a secondary chronic headache disorder. This condition is defined as headaches occurring for 15 or more days per month for 3 or more months in patients taking acute headache treatments too frequently. Medication overuse headaches are believed to occur when medications intended to relieve headaches are consumed frequently. Causal agents are varied and can include agents such as nonsteroidal anti-inflammatory drugs, triptans, ergot derivatives, and opioids, although any analgesic can potentially trigger the medication overuse headache. […] Medication overuse headaches are believed to occur when patients frequently use acute headache medications at the following rates15 or more days per month for simple analgesics, such as acetaminophen and NSAIDs, and 10 or more days per month for ergotamine, triptans, opioids, or combination analgesics, such as butalbital, acetaminophen, or caffeine.

• #64 Medication Overuse Headache: What Is It and Why Is It Happening? – Migraine Canada

  https://migrainecanada.org/medication-overuse-headache-what-is-it-and-why-is-it-happening/

  MOH occurs when the medications used to alleviate headaches are taken too frequently, inadvertently exacerbating the problem they were intended to solve. […] Many studies have shown this. […] MOH is thought to affect 1 to 2% of the general population, so yes, it is common, and no, you’re not the only one. […] According to the International Headache Classification: Ten days per month for triptans, opioids, and any mix of medication. […] Many experts set the limit at treating 2-3 days per week to stay on the safe side, but many people with clear MOH use acute treatments more than 20 days per month or almost daily. […] The term medication overuse headache is used if there is evidence or a strong impression that the overuse contributes to chronic headaches. […] The migraine brain has a particular chemical software. Genes are involved. We know that if it is exposed to medications acting on pain networks, the pain networks change, and pain increases.

• #65 Medication Overuse Headache: What Is It and Why Is It Happening? – Migraine Canada

  https://migrainecanada.org/medication-overuse-headache-what-is-it-and-why-is-it-happening/

  MOH occurs when the medications used to alleviate headaches are taken too frequently, inadvertently exacerbating the problem they were intended to solve. […] Many studies have shown this. […] MOH is thought to affect 1 to 2% of the general population, so yes, it is common, and no, you’re not the only one. […] According to the International Headache Classification: Ten days per month for triptans, opioids, and any mix of medication. […] Many experts set the limit at treating 2-3 days per week to stay on the safe side, but many people with clear MOH use acute treatments more than 20 days per month or almost daily. […] The term medication overuse headache is used if there is evidence or a strong impression that the overuse contributes to chronic headaches. […] The migraine brain has a particular chemical software. Genes are involved. We know that if it is exposed to medications acting on pain networks, the pain networks change, and pain increases.

• #66 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. Certain medications such as triptans, opioids and ergots are known to be associated with MOH. […] The underlying mechanism leading to this condition is still unknown. Lots of factors such as genetic predisposition or behavioural/environmental factors have been reported to trigger and maintain these headaches. […] Children with a predisposition to headaches are thought to have a great sensitivity to pain when they use medications frequently and this increases their tendency to MOH. […] The risk of developing MOH varies with different treatments: Highest with opioids and triptans, Intermediate with paracetamol and aspirin, Lowest with non-steroidal anti-inflammatory drugs such as ibuprofen.

• #67 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. Certain medications such as triptans, opioids and ergots are known to be associated with MOH. […] The underlying mechanism leading to this condition is still unknown. Lots of factors such as genetic predisposition or behavioural/environmental factors have been reported to trigger and maintain these headaches. […] Children with a predisposition to headaches are thought to have a great sensitivity to pain when they use medications frequently and this increases their tendency to MOH. […] The risk of developing MOH varies with different treatments: Highest with opioids and triptans, Intermediate with paracetamol and aspirin, Lowest with non-steroidal anti-inflammatory drugs such as ibuprofen.

• #68 Medication overuse headache | MedLink Neurology

  https://www.medlink.com/articles/medication-overuse-headache

  People using medication containing barbiturates or opiates had a two-fold higher risk of developing chronic headache than those using single analgesics or triptans. […] Obesity and metabolic syndrome have increasingly been recognized as an important risk factor for medication overuse headache. […] Depression and anxiety are more frequent in patients with medication overuse headache and seem to increase the risk of developing chronic headache by 50%. […] The pathophysiology of medication overuse headache still remains unclear. […] The number of animal studies has increased significantly. […] Genetic studies on medication overuse headache are ambiguous. […] There is growing evidence that central sensitization may play an important role in the pathophysiology of chronic headache. […] Psychological factors include the reinforcing properties of pain relief by drug consumption, a powerful component of positive conditioning. […] Withdrawal headache is an additional factor.

• #69 Medication overuse headache – Wikipedia

  https://en.wikipedia.org/wiki/Medication_overuse_headache

  It is thought that rebound headaches are caused by a neuronal re-adjustment process. […] The time it takes for someone to develop medication overuse headaches (MOH) after taking medication too often depends on the type of medication they are using. […] The underlying mechanisms that lead to the development of the condition are still widely unknown and clarification of their role is hampered by a lack of experimental research or suitable animal models. […] In some cases, individuals may be genetically predisposed to developing medication overuse headache.

• #70 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. […] 8.2 Medication-overuse headache is an interaction between a therapeutic agent used excessively and a susceptible patient. […] 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. […] 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.

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

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

  Some medicines are more likely than others to cause medication-overuse headaches. […] The risk of developing medication-overuse headache is much more closely linked to taking these medicines regularly over a long period – at least three months – than to the dose you take over a shorter period. […] Medication-overuse headache may, however, develop in some people who take less than this. […] The amount and frequency of medication use needed to cause medication-overuse headache is not clear. […] Medication-overuse headache is much less likely to develop if you take painkillers regularly for other painful conditions such as arthritis. […] However, if you are already prone to headaches, you may develop medication-overuse headache if you are taking regular painkillers, even if you aren’t originally taking them for headache.

• #72 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

  Medication overuse in primary headache disorders is a worldwide phenomenon and has a role in the chronification of headache disorders. […] The underlying consensus for the entity of medication-overuse headache (MOH) consists of a deterioration of a pre-existing headache syndrome whilst overusing one or several types of acute painkilling treatments. […] Medication overuse was found to be an important risk factor for chronification of primary headaches. […] An important risk factor for the development of MOH is predisposition for migraine or tension-type headache as an underlying biological trait. […] The burden of disease for MOH has been shown to be a worldwide problem. […] A complete understanding of the pathophysiology of MOH currently does not exist. […] Medication overuse headache (MOH) is recognized as a separate secondary entity next to mostly primary headache disorders, although many clinicians see the disease as a sole complication of primary headache disorders.

• #73 Rebound Headache: What It Feels Like, Causes, Treatment

  https://www.verywellhealth.com/rebound-headache-8391723

  Rebound headaches, also called medication-overuse headaches, are caused by the excessive use of acute (short-term) headache medication in people with a prior history of headaches, usually migraine or tension-type. […] Rebound headaches are caused by the regular overuse of headache medication for over three months. Medication overuse is defined as taking headache medicine for 10 to 15 days or more per month, depending on the specific drug class. […] Rebound headaches occur 15 or more days per month and only develop in a person with a preexisting primary headache disorder. […] The most common primary headache disorder associated with rebound headaches is migraine. […] People with rebound headaches often report a history of migraine attacks that have slowly transformed over months to years from episodic to chronic form, thereby requiring more acute migraine medications.

• #74 Rebound Headache: What It Feels Like, Causes, Treatment

  https://www.verywellhealth.com/rebound-headache-8391723

  Rebound headaches, also called medication-overuse headaches, are caused by the excessive use of acute (short-term) headache medication in people with a prior history of headaches, usually migraine or tension-type. […] Rebound headaches are caused by the regular overuse of headache medication for over three months. Medication overuse is defined as taking headache medicine for 10 to 15 days or more per month, depending on the specific drug class. […] Rebound headaches occur 15 or more days per month and only develop in a person with a preexisting primary headache disorder. […] The most common primary headache disorder associated with rebound headaches is migraine. […] People with rebound headaches often report a history of migraine attacks that have slowly transformed over months to years from episodic to chronic form, thereby requiring more acute migraine medications.

• #75 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

  However, the possibility that some of what is overuse is simply a consequence of severe and frequent headache, i.e. driven the underlying disease, needs to be considered. […] Overuse of simple analgesics is considered above 15 days a month, whereas 10 or more days taking opioids or triptans as well as combinations of painkillers, are defined as MOH. […] A longitudinal study revealed that patients with episodic migraine were more likely to progress to chronic migraine if they were taking medication containing opioids or barbiturates, suggesting a medication-dependent effect. […] Indeed, are some patients simply responding to increased attack frequency by increasing acute attack medication use? […] A study of 110 rheumatology patients showed that 8 of them had chronic daily headache, which were preceded by regular use of analgesics in 5/8 patients.

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

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

  As the name implies, chronic medication overuse is the most significant risk factor for the development of MOH, with each class of analgesics carrying a different risk profile. […] The risk from lowest to highest is: triptans/ergotamine, single analgesic agents (NSAIDs, acetaminophen), and combination analgesics containing opiates or barbiturates. […] Some studies suggest that NSAIDs may have a protective effect from MOH in patients with ten headache days or less per month. […] Of all headache types, migraine is the one most commonly associated with MOH and occurs in approximately 80% of patients. […] Patients with higher headache frequency at baseline are also at higher risk for MOH. […] It is unknown if the high headache frequency leads to more drug consumption and thus MOH or if patients with higher frequency attacks are more prone to MOH.

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

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

  As the name implies, chronic medication overuse is the most significant risk factor for the development of MOH, with each class of analgesics carrying a different risk profile. […] The risk from lowest to highest is: triptans/ergotamine, single analgesic agents (NSAIDs, acetaminophen), and combination analgesics containing opiates or barbiturates. […] Some studies suggest that NSAIDs may have a protective effect from MOH in patients with ten headache days or less per month. […] Of all headache types, migraine is the one most commonly associated with MOH and occurs in approximately 80% of patients. […] Patients with higher headache frequency at baseline are also at higher risk for MOH. […] It is unknown if the high headache frequency leads to more drug consumption and thus MOH or if patients with higher frequency attacks are more prone to MOH.

• #78 10 Things You Need to Know About Medication-Overuse Headache

  https://www.everydayhealth.com/migraine/things-you-need-to-know-about-medication-overuse-headache/

  Taking simple analgesics, including nonsteroidal anti-inflammatories (NSAIDs) a drug class that includes aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) on 15 or more days a month also constitutes overuse. […] The more headache days a person has, the more likely they are to transform to chronic migraine, says Tepper. […] Studies conducted both in the general population and in clinics show that people who have 10 to 14 headache days per month are 20 times more likely to develop daily headache than people who have fewer than five headache days per month, he says. […] The frequency of the headache days is actually a big risk for transforming, and the frequency of headaches is linked to how many times somebody reaches for an acute medication to treat, says Tepper, adding that although these are separate risks, they feed each other.

• #79 10 Things You Need to Know About Medication-Overuse Headache

  https://www.everydayhealth.com/migraine/things-you-need-to-know-about-medication-overuse-headache/

  Taking simple analgesics, including nonsteroidal anti-inflammatories (NSAIDs) a drug class that includes aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) on 15 or more days a month also constitutes overuse. […] The more headache days a person has, the more likely they are to transform to chronic migraine, says Tepper. […] Studies conducted both in the general population and in clinics show that people who have 10 to 14 headache days per month are 20 times more likely to develop daily headache than people who have fewer than five headache days per month, he says. […] The frequency of the headache days is actually a big risk for transforming, and the frequency of headaches is linked to how many times somebody reaches for an acute medication to treat, says Tepper, adding that although these are separate risks, they feed each other.

• #80 Understanding the pathophysiology of medication overuse headache | MDedge

  https://www.mdedge.com/migraine-icymi/article/242061/understanding-pathophysiology-medication-overuse-headache

  This suggests a cause-and-effect relationship, indicating that medication use causes transformation to medication overuse headache in patients with preexisting headache disorders—and is not the result of it. […] The higher prevalence of psychiatric comorbidities, including depression, anxiety disorders, sleep disturbance, and non-cephalic body pain, suggest that they may either be causative or just comorbid. […] For medication overuse headache to develop, clinicians should see an underlying primary headache worsen with frequent acute care medication use as well as peripheral trigeminal nociceptor activation. […] Research shows that in individuals who experience medication overuse headache, platelet serotonin is decreased and the density of serotonin receptors on platelets is increased, implying suppressed serotonin function.

• #81 Medication-Overuse Headache

  https://practicalneurology.com/articles/2018-feb/medication-overuse-headache

  MOH, by definition, occurs only in individuals who already have a headache disorder. It does not occur de novo without history of headache. […] It is unclear whether MOH is a consequence of living with chronic daily headache or the reverse, but it is clear that withdrawal of the overused drug(s) bring(s) relief to the majority of patients, suggesting a causative role for the medications. […] Alteration of cortical activity, central sensitization of the nociceptive trigeminal system, and changes in serotonin and dopamine expression and cannabinoid and calcitonin gene-related peptide receptors have all been considered as potential pathways for MOH. […] MOH produces central sensitization with structural and functional changes in the trigeminal nucleus caudalis, resulting in a decrease in the pain threshold and an increase in receptive fields.

• #82 Understanding the pathophysiology of medication overuse headache | MDedge

  https://www.mdedge.com/migraine-icymi/article/242061/understanding-pathophysiology-medication-overuse-headache

  This suggests a cause-and-effect relationship, indicating that medication use causes transformation to medication overuse headache in patients with preexisting headache disorders—and is not the result of it. […] The higher prevalence of psychiatric comorbidities, including depression, anxiety disorders, sleep disturbance, and non-cephalic body pain, suggest that they may either be causative or just comorbid. […] For medication overuse headache to develop, clinicians should see an underlying primary headache worsen with frequent acute care medication use as well as peripheral trigeminal nociceptor activation. […] Research shows that in individuals who experience medication overuse headache, platelet serotonin is decreased and the density of serotonin receptors on platelets is increased, implying suppressed serotonin function.

• #83 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. Certain medications such as triptans, opioids and ergots are known to be associated with MOH. […] The underlying mechanism leading to this condition is still unknown. Lots of factors such as genetic predisposition or behavioural/environmental factors have been reported to trigger and maintain these headaches. […] Children with a predisposition to headaches are thought to have a great sensitivity to pain when they use medications frequently and this increases their tendency to MOH. […] The risk of developing MOH varies with different treatments: Highest with opioids and triptans, Intermediate with paracetamol and aspirin, Lowest with non-steroidal anti-inflammatory drugs such as ibuprofen.

• #84 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. Certain medications such as triptans, opioids and ergots are known to be associated with MOH. […] The underlying mechanism leading to this condition is still unknown. Lots of factors such as genetic predisposition or behavioural/environmental factors have been reported to trigger and maintain these headaches. […] Children with a predisposition to headaches are thought to have a great sensitivity to pain when they use medications frequently and this increases their tendency to MOH. […] The risk of developing MOH varies with different treatments: Highest with opioids and triptans, Intermediate with paracetamol and aspirin, Lowest with non-steroidal anti-inflammatory drugs such as ibuprofen.

• #85 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. Certain medications such as triptans, opioids and ergots are known to be associated with MOH. […] The underlying mechanism leading to this condition is still unknown. Lots of factors such as genetic predisposition or behavioural/environmental factors have been reported to trigger and maintain these headaches. […] Children with a predisposition to headaches are thought to have a great sensitivity to pain when they use medications frequently and this increases their tendency to MOH. […] The risk of developing MOH varies with different treatments: Highest with opioids and triptans, Intermediate with paracetamol and aspirin, Lowest with non-steroidal anti-inflammatory drugs such as ibuprofen.

• #86 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. Certain medications such as triptans, opioids and ergots are known to be associated with MOH. […] The underlying mechanism leading to this condition is still unknown. Lots of factors such as genetic predisposition or behavioural/environmental factors have been reported to trigger and maintain these headaches. […] Children with a predisposition to headaches are thought to have a great sensitivity to pain when they use medications frequently and this increases their tendency to MOH. […] The risk of developing MOH varies with different treatments: Highest with opioids and triptans, Intermediate with paracetamol and aspirin, Lowest with non-steroidal anti-inflammatory drugs such as ibuprofen.

• #87 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

  This caused the entity of definite MOH to be diagnosed retrospectively and more difficult to handle in clinical practice. […] The knowledge on the pathophysiology of MOH involves conversion from and reversion to primary headache disorders, showing changes in physiological processes, functional connectivity and structural changes of the central nervous system, in patients with underlying genetic susceptibility. […] Changes in pain processing networks, dependence networks, sensitization and receptor density in the CNS presumably explain the clinical characteristics of the disorder.

• #88 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

  This caused the entity of definite MOH to be diagnosed retrospectively and more difficult to handle in clinical practice. […] The knowledge on the pathophysiology of MOH involves conversion from and reversion to primary headache disorders, showing changes in physiological processes, functional connectivity and structural changes of the central nervous system, in patients with underlying genetic susceptibility. […] Changes in pain processing networks, dependence networks, sensitization and receptor density in the CNS presumably explain the clinical characteristics of the disorder.

• #89 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

  This caused the entity of definite MOH to be diagnosed retrospectively and more difficult to handle in clinical practice. […] The knowledge on the pathophysiology of MOH involves conversion from and reversion to primary headache disorders, showing changes in physiological processes, functional connectivity and structural changes of the central nervous system, in patients with underlying genetic susceptibility. […] Changes in pain processing networks, dependence networks, sensitization and receptor density in the CNS presumably explain the clinical characteristics of the disorder.

• #90 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

  This caused the entity of definite MOH to be diagnosed retrospectively and more difficult to handle in clinical practice. […] The knowledge on the pathophysiology of MOH involves conversion from and reversion to primary headache disorders, showing changes in physiological processes, functional connectivity and structural changes of the central nervous system, in patients with underlying genetic susceptibility. […] Changes in pain processing networks, dependence networks, sensitization and receptor density in the CNS presumably explain the clinical characteristics of the disorder.

• #91 Medication Overuse Headache: Causes, Consequences, and Treatment | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4614-3375-0_28

  Although many questions remain unanswered, it is encouraging that several clinical and experimental advances have shed new light on the neuropharmacology of nociception and have prompted new hope for more effective treatments of such diverse problems as chronic headache pain, migraine, and drug dependency.

• #92 Medication Overuse Headache: Causes, Consequences, and Treatment | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4614-3375-0_28

  Although many questions remain unanswered, it is encouraging that several clinical and experimental advances have shed new light on the neuropharmacology of nociception and have prompted new hope for more effective treatments of such diverse problems as chronic headache pain, migraine, and drug dependency.

• #93 Medication Overuse Headache: Causes, Consequences, and Treatment | SpringerLink

  https://link.springer.com/chapter/10.1007/978-1-4614-3375-0_28

  All primary headache subtypes (migraine, tension-type headache, cluster headache) may become complicated by medication overuse headache (MOH). MOH has developed into the third most common type of headache after tension-type headache and migraine. The prevalence reaches approximately 1% of the worlds population and shows an increasing trend. MOH is a condition in which headaches become increasingly frequent as a patient begins to use more and more acute headache medications. The initial headache frequency is one of the factors that may play a role in the development of MOH. However, the reasons why some patients overuse acute treatments of headaches whereas others do not are not clearly understood. MOH might be prompted and sustained by some psychological states and behavioral disorders, including fear of headache, anticipatory anxiety of attacks, and psychological drug dependence. A range of behaviors presumed to be related to excessive medications are being increasingly recognized in MOH disease. These behaviors are linked by their reward-based and repetitive natures. Whether these behaviors are simply related to medications interacting with an underlying individual vulnerability or whether the primary pathological features of MOH play a role is not known. Neurobiological mechanisms underlying drug dependence and reward system (i.e. endocannabinoids, dopamine, orexins) might also be involved in MOH. The study of these neurobiological mechanisms and behaviors might allow not only a greater insight into the pathophysiology of MOH but also an improved clinical management of this disorder.

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