Materiały źródłowe

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

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

  Medication-overuse headaches (MOH), also known as analgesic rebound headaches, drug-induced headaches, or medication-misuse headaches, are a common neurologic disorder that results in enormous disability and suffering and plays a significant role in the transformation from episodic to chronic headache disorders. […] This activity reviews the presentation, evaluation, and management of medication-overuse headaches and highlights the role of an interprofessional team approach to the care of affected patients. […] The management approach includes patient education, effective prophylaxis, discontinuation of the overused analgesic, and follow-up to prevent a recurrence. […] MOH is felt to be a preventable disease; therefore, the emphasis should be on educating patients on the importance of appropriate medication administration and the risks not only of its side effects but also the potential development of chronic headaches with excessive medication use is essential. […] Specific transitional strategies can be used to help discontinue the overused medication and hence reduce MOH.

• #2 Medication overuse and migraine: Is there a connection?

  https://www.medicalnewstoday.com/articles/can-the-overuse-of-medication-cause-chronic-migraines

  Overusing some medications may trigger chronic migraine. Taking too much headache medication can also turn occasional migraine attacks into chronic migraine. […] Taking headache or migraine medication too frequently can lead to medication overuse headache (MOH). […] Treatment for MOH involves completely weaning a person off the pain medication they are taking and finding a more effective alternative. […] Doctors treat MOHs by weaning people off the medication, causing rebound headaches. They may also recommend other treatments for recurring head pain or chronic migraine.

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

• #4

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

  Join IHS in creating awareness of Medication-Overuse Headache. Share our videos in your social networks. […] MOH is per definition an inappropriately treated headache. Therefore, treatment of MOH, can be viewed as an adjustment of the treatment towards a more efficient and optimal headache treatment. […] Evidence based treatment of MOH consists of three elements: 1) Withdrawal of the overused and inefficient acute medication; 2) Adding an efficient preventive treatment strategy; and 3) Close follow-up and use of headache calendar. […] When talking about withdrawal, the most efficient way, is to be without any painkillers or acute migraine medication for two months. Another approach, though less efficient in reducing the headache burden, would be to cut down the use of acute medication to maximum two days a week.

• #5 S5:Ep12 – Understanding Medication Overuse Headache (Rebound Headache) – Association of Migraine Disorders

  https://www.migrainedisorders.org/podcast/s5ep12-understanding-medication-overuse-headache-rebound-headaches/

  So the pain relievers and anti-migraine medications can effectively alleviate the headaches when taken as needed. However, in patients with primary headache disorders or other headache disorders, for example, with migraines or tension-type headache, these patients should be cautious about using these medications excessively because taking these medications on 2 or more days per week can actually trigger medication-overuse headaches. […] Medication-overuse headache affects over half of patients with chronic headaches, essentially with those who have headaches on 15 or more days per month, with an estimated 59 million people worldwide who are affected by these headaches. […] Medication-overuse headache is a disabling condition. It’s ranked among the top 20 diseases carrying years of life lost due to disability.

• #6 Medication overuse headache – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/medication-overuse-headache-1.html

  Medication overuse headache is common, affecting at least 1% of the population. […] Withdrawal of the inciting medication(s) is the only effective treatment. […] The essential treatment of medication overuse headache is withdrawal of the offending medication, but in most cases that is easier said than done. […] Prophylactic medication can be commenced before drug withdrawal. […] Following successful withdrawal of the overused medication, migraine prophylaxis, careful assessment of precipitants, counselling, a headache management plan and clear limits on the use of analgesia may all be required in order to prevent relapse. […] Medication must be withdrawn to treat the condition. A comprehensive management plan should be implemented to prevent relapse.

• #7 Preventing and treating medication overuse headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5741367/

  Early discontinuation of overused medications is the first line of management. […] For many uncomplicated patients, advice to discontinue the overused medication may be sufficient, with success rates of up to 70%. […] Adding preventive medication at the outset is at least as effective as, and causes less headache suffering than, withdrawal without such medication. […] Medication overuse headache can be both prevented and treated, but it is not always an easy task.

• #7 Preventing and treating medication overuse headache

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5741367/

  Medication overuse headache is a secondary headachea worsening of a pre-existing headache (usually a primary headache) owing to overuse of one or more attack-aborting or pain-relieving medications. […] Treatment guidelines for MOH are based on expert consensus and include withdrawal strategies, treatment of withdrawal headache, and eventually prophylactic medication for the underlying headache. […] Reducing the dose and eventually discontinuing the overused medication are the natural first choices of treatment, but experts differ on the best way to do so. […] Most experts now regard withdrawal of the overused medication as the treatment of choice, as it often leads to improvement of the headache. […] In general, around 50% to 70% of patients with MOH seem to respond well to withdrawal therapy, and no withdrawal regime seems to be superior.

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

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

  Replacing the overused medication with an alternative symptomatic therapy: The overused magic medication is stopped, preventive therapy is started or optimized, and alternative symptomatic medication is used for less than or equal to 2 days a week. […] This approach is supported by evidence from open-labeled clinical trials. […] A guideline from the European Federation of Neurological Sciences recommends the abrupt discontinuation of the overused medication and if started prophylactic therapy initiation just before or at the time of drug discontinuation with close regular follow-up. […] To date, therapy with beta-blockers, calcium channel blockers, tricyclic antidepressants, and anticonvulsants have all been utilized. […] The COMOESTAS project demonstrated that the combination of detoxification and prophylaxis of MOH patients decreased disability, depression, and anxiety. […] This group developed an evidence-based treatment protocol and at the end of their trial, 66% of MOH patients no longer overused medications and 47% reverted back to episodic headaches.

• #9 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. […] 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. […] Discontinuation of overused medication is essential and the treatment of choice for MOH. […] There are various strategies to help with process of medication withdrawal and bridge therapy may be useful during drug withdrawal to provide symptomatic relief.

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

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

  Rebound headaches, formally known as medication overuse headaches, happen when you treat headaches with medication too often, causing more headaches, which can be even worse. Fortunately, theyre treatable and preventable. […] Rebound headaches are very treatable. There isnt a cure for them, but treatment can make them stop. […] Treatment involves the following: […] Stopping the medication(s) contributing to the rebound headaches. This is the most important part of treating rebound headaches, and the stoppage has to be total for this to work. […] Alternate medications. Switching medications can help with the headache symptoms while you avoid taking the medication(s) that caused the rebound headaches. […] Nonmedication treatments. These help you adjust your body and mind to the changes in your treatment, especially if you have symptoms like anxiety or depression.

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

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

  Yes, rebound headaches are very preventable. The key to preventing them is limiting how often you use medications of any kind to treat your headaches. […] If you have questions about how you can prevent migraines or headaches, talk to your healthcare provider. They can offer a range of treatment options, including medications and other methods, which might help reduce migraine and headache frequency and severity. […] Stopping the medication(s) causing the rebound headaches is essential to reversing this condition. […] Most people will see their rebound headaches fade and stop within two months. For more severe cases, it may take up to six months. […] The outlook for rebound headaches is generally positive, especially if you recognize them and get treatment sooner rather than later.

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

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

  Medication-overuse headache is a cause of frequent headaches caused by taking painkillers or triptan medicines regularly for headaches or migraine. […] The only effective treatment is to stop the medication that is causing it. This often causes headaches or migraines to get worse for a short time, before improving afterwards. […] The most important part of treatment is to recognise and understand the cause of your frequent headaches – the painkillers or triptans. […] You can then devise a plan to stop the painkillers. This is best done with the advice of a doctor. it’s best to plan a day to stop them altogether rather than try to cut down gradually. You should stop taking them for at least one month, and possibly two. […] You must stop the painkillers or triptan completely to cure the problem.

• #12 Medication-Overuse Headache

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

  With treatment, 72% of patients have at least 50% fewer headaches within 1 to 6 months. Relapse is relatively high at 31%, 41%, and 45% at 6 months, 1 year, and 4 years, respectively. […] The high rate of relapse and high cost of MOH makes prevention of great importance. Use of acute medications in patients with episodic and chronic migraine should be carefully limited.

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

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

  Abrupt, sudden removal is considered the treatment of choice for triptans, ergots, simple and combination analgesics, and NSAIDs. […] Gradual withdrawal is best for the overuse of opioids, barbiturates, and benzodiazepines. […] The European Federation of Neurological Sciences recommends that if prophylactic therapy has started before or at the time of abrupt withdrawal of the overused medication, preventive therapies should be at the lowest doses, then dosage can be titrated up with time. […] Recent studies looked at the prophylactic effect of anti-calcitonin gene-related peptide receptor (anti-CGRP) monoclonal antibodies (MAB) in MOH. […] Proper approach for MOH is crucial, as well as the need for appropriate clinical assessment and a treatment strategy for the overused medication. […] Treatment strategies vary by medication.

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

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

  Medication-overuse headache (MOH) is a disabling secondary headache disorder, with challenging consequences for affected patients and health care resources. […] New advances in headache neurosciences and development of new treatment options specific for headache, along with an understanding of the clinical profile and pathophysiological mechanisms of MOH, can help improve patient outcomes and decrease the burden on the health care system. […] The objective of this work is to review MOH and to identify its updated clinical assessments and recent management approaches. […] Educating patients, the general population, and healthcare providers about MOH and analgesic overuse especially when headache sufferers take it for any primary headache disorders can prevent the development of MOH. […] Management strategies for withdrawing from drug overuse can be abrupt or gradual.

• #14 Stopping the vicious cycle of rebound headaches – Harvard Health

  https://www.health.harvard.edu/blog/stopping-the-vicious-cycle-of-rebound-headaches-2019110718180

  Rebound headaches, also known as medication overuse headaches, are caused by the frequent or excessive use of pain-relieving and/or antimigraine drugs to treat headache attacks that are already in progress. […] Medication overuse headaches usually stop when a person stops taking the headache medication. It may be difficult in the beginning, because once you stop your medication, your headache is likely to get worse before it gets better. But medications that prevent headaches, and nonmedical therapies such as biofeedback and avoiding headache triggers, can help get a person through this medication withdrawal period. […] Some headache medications can be discontinued abruptly, while others may need to be tapered slowly. For example, following long-term use, opioids and butalbital-containing medications should not be stopped abruptly. Doing so may lead to withdrawal symptoms such as sweating, shaking, nausea, vomiting, diarrhea, body aches, anxiety, irritability, or runny nose. Abrupt discontinuation of butalbital may result in seizures. Some people may benefit from discontinuing these medications in an inpatient setting. If you are taking opioids or butalbital-containing medications, talk to your doctor.

• #14 Stopping the vicious cycle of rebound headaches – Harvard Health

  https://www.health.harvard.edu/blog/stopping-the-vicious-cycle-of-rebound-headaches-2019110718180

  The following steps can help stave off rebound headaches. Limit the use of any headache medications taken as needed to relieve headache pain to no more than two to three days per a week (or less than 10 days per month). Contact your doctor if you need to take headache medications more than two days per week. Contact your doctor if you have headache more than four days per month. You may need to be on headache preventive medication. Avoid using butalbital-containing medications or opioids. Control and avoid anything that triggers your headaches. Common triggers include dehydration, hunger, lack of sleep, stress, and certain foods and drinks.

• #15

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

  Tapered withdrawal is recommended for benzodiazepines, opioids, and barbiturates, but in other cases abrupt withdrawal is recommended, with or without another medication to ameliorate withdrawal symptoms. […] The most common symptom is an initial worsening of the headache, accompanied by various degrees of nausea, vomiting, hypotension, tachycardia, sleep disturbance, restlessness, anxiety, and nervousness. […] A systematic review of articles published between 2004 and 2014, which classified evidence in accordance with the American Academy of Neurology’s Clinical Practice Guideline Manual, indicated a better outcome if onabotulinumtoxin type A and topiramate were used in patients with chronic migraine plus MOH. […] Given these results, the authors suggested discontinuation of the overused medication with the addition of preventive medication, but they called for more adequately sized RCTs.

• #15

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

  Outpatient withdrawal should probably be offered to most patients, but complicated cases may require inpatient treatment. […] A brief intervention, consisting mainly of advice to MOH patients, was found highly effective in a recent RCT from a Norwegian primary care setting. […] Educational strategies to increase knowledge among health care providers to identify patients at risk and inform their patients about the risks and modify their headache management habits, information campaigns to raise public awareness, and warning labels on over-the-counter analgesics are possible preventive strategies. […] Studies have reported relapse rates of 20% to 60% (with the majority between 25% and 35%) of patients within the first year after withdrawal, but few relapses after 12 months. […] Medication overuse headache can be both prevented and treated, but it is not always an easy task.

• #16 Medication overuse headache – Wikipedia

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

  A medication overuse headache (MOH), also known as a rebound headache, usually occurs when painkillers are taken frequently to relieve headaches. […] MOH is a serious, disabling and well-characterized disorder, which represents a worldwide problem and is now considered the third-most prevalent type of headache. […] The treatment of choice is abrupt drugs withdrawal, followed by starting prophylactic therapy. […] However, the discontinuation of overused drugs may lead to the initial worsening of headaches, nausea, vomiting, sleep disturbance, anxiety, and restlessness. […] It is important that the patient’s physician be consulted before abruptly discontinuing certain medications as such a course of action has the potential to induce medically significant physical withdrawal symptoms.

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

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

  In some cases, patient education to let them know their safe limits is simply all that is required. […] There was a study in 2018 that essentially showed that a complete stop of acute medication during a two month detoxification period was the most effective treatment in terms of percentage reduction in headache days per month, six months after the intervention. […] The group that stopped all acute medicinal treatments and worked on other techniques such as pain management or cognitive behavioral type techniques did better. […] During the withdrawal period, headache can initially get worse as less medication is taken and people can also experience nausea or vomiting. […] A greater occipital nerve blockade (GON) can be particularly useful when anticipating an upcoming withdrawal period due to medication overuse headache.

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

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

  The other strategy to consider is starting a preventive. […] Preventive therapies are another important tool to break this cycle. […] When a preventive treatment is used, chronic migraine and MOH often revert to episodic headache. […] If a patient fails to respond, tolerate or adhere to treatment then inpatient treatment may be considered. […] Awareness is a big part of the answer. Awareness amongst patients, the public, GPs and health care workers such as pharmacists are important for prevention. […] Use acute headache treatment within the frequency limits to prevent MOH.

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

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

  Medication overuse headache is a subgroup of headache and it is important to those with migraine and tension type headache. […] MOH can be subclassified by drug type. These classes include triptans, simple analgesics (pain relievers), opioids, or combination treatments. […] The evidence strongly suggests that MOH can make an already difficult situation difficult to treat or even worsen the condition. […] MOH can increase headache frequency and make the disease even less responsive to a management strategy, including some preventive treatments. […] MOH is reversible, it is curable in that sense. The underlying migraine condition is not necessarily curable at this stage, but this MOH component of it certainly is reversible with cessation or withdrawal of the drug. […] What are the limits that can be taken to avoid falling into the trap of MOH? The answer varies according to what treatment class is being taken.

• #18 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-is-Medication-Overuse-Headache.aspx

  Medication overuse headache, which is also known as medication-induced headache, is a type of headache that is caused by the frequent administration of analgesic or triptan medications that are often used to treat headaches or migraines. […] The essential step in the treatment of medication overuse headache is to cease treatment with the causative medication. This typically worsens the symptoms of headache initially; however, over a period of a few weeks (up to 2 months), the headaches tend to reduce in frequency and fall back into a normal pattern of occurrence. […] In most cases, it is recommended to stop taking the analgesic medications completely on a particular day, rather than gradually reducing the dose. […] After 2-8 weeks, the pattern of the headaches should revert back into their original pattern, with significantly less frequency. At this point, preventative treatment for the headaches can be commenced. […] Prophylactic medications to prevent future headaches or migraines can be a good option to reduce the frequency of symptoms.

• #19 Medication overuse headache – National Migraine Centre

  https://www.nationalmigrainecentre.org.uk/understanding-migraine/factsheets-and-resources/medication-overuse-headache/

  Overuse of painkillers cause the nerves in the brain to become hypersensitive and mis-fire without being stimulated by the usual triggers. […] Stopping suddenly works best for most people. This is difficult for the first couple of weeks as the pain often increases before it improves. […] Recent research has shown that a period of time taking no medication (usually between six and 12 weeks) is most effective. […] After two months of addressing medication overuse, ideally with no short-term drugs at all, there are three possible headache outcomes. […] Medication overuse headache tends to happen to people with severe migraine so there is a high risk of headache recurring. Pay careful attention to lifestyle triggers and restrict your use of acute medication. […] Book an appointment with the experts: get on top of medication overuse headache and review the best treatment options for you with a leading headache specialist.

• #20 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

  MOH therapy can be challenging for clinicians to manage. […] A medium through which treatment would be eased is patient education. […] A study led by Fritsche and colleagues suggested that patients who were made aware of the prevention of MOH, through bibliotherapy resulted in no development of MOH in the study group and resulted in a significant reduction in both headache days and pain-related parameters. […] The largest study trying to answer this question specifically was the COMOESTAS study. […] Of note, in a Danish study abrupt detoxification has been shown more feasible for patients and proven to be more effective in reducing headache-related anxiety than gradual medication withdrawal as well as reducing disability as per the Headache Under-Response to Treatment index (HURT).

• #20 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

  Medication-overuse headache (MOH), which potentially involves 12% of the population, is defined as a headache, on 15 days a month affected, along with overuse of one or other acute attack medications. […] Through a review of the current literature and our clinical experience, we have explored the mechanisms through which MOH may occur, provide an understanding of the current state of treatment and detail some possible views on the understanding and treatment of this condition. […] Above all interventions, patient education is crucial, which is underscored by an analysis of the academic publications. Given the condition is preventable, early intervention is imperative and patient awareness is highlighted as key. […] Currently, MOH is a well-accepted cause of chronic daily headache. […] The development of gepants, CGRP receptor antagonists, for the preventive treatment of migraine offers an important advance since if these medicines, useful also for acute treatment do not cause MOH, this would be a crucial advance.

• #20 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

  Although studies show the utility of medication withdrawal, few studies have been completed on the use of bridge therapies often used by neurologists before or following medication withdrawal. […] Other treatments have been used as bridge therapies with only small studies and not as extended use. […] Although this question had not been answered until recently, adding a preventive medication to complete withdrawal treatment may be of use given current evidence. […] Overall, the evidence suggests that there should be an emphasis on patient education. […] Various guidelines are available, such as those of the European Academy of Neurology and French Society of Neurology guidelines have some alignment: they both suggest that education and then withdrawal is the best approach.

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

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

  Your healthcare professional may prescribe treatments to help with headache pain and the side effects of medicine withdrawal. This is called bridge or transitional therapy. Treatments may include nonsteroidal anti-inflammatory drugs, corticosteroids, nerve blocks and anti-nausea medicines. Your healthcare professional also might suggest that you take the ergot dihydroergotamine through a vein. […] Preventive medicines may help you break the cycle of medication overuse headaches and ease the underlying headache condition, such as migraine. Work with your healthcare professional to keep from relapsing and to find a safer way to manage your headaches. During or after withdrawal, your healthcare professional may prescribe a daily medicine to prevent headaches such as: […] Shots of onabotulinumtoxinA (Botox) may help lower the number of headaches you have each month. They also may make headaches less severe.

• #22 Headache from Medication Overuse | AMF

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

  Apart from discontinuation, a combination of pharmacological therapy, non-pharmacological therapy, biofeedback, and targeted physical therapy is needed for improvement in the patient’s symptoms. […] 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. […] Other outpatient therapies include biofeedback, psychological counseling, and physical therapy, which help effectively work on changing lifestyle and incorporating non pharmacological therapies for the management of headaches. […] It is important to know that intake of medications for acute treatment should be limited to less than two times per week. […] Patients should remember to contact their physicians and let them know if they need to take medications for acute treatment frequently so that the appropriate management can be done and the onset of medication overuse headaches can be avoided.

• #23 Comparing Two Ways to Manage Symptoms for Patients Who Have Chronic Migraine and Frequent Medication Use — The MOTS Trial | PCORI

  https://www.pcori.org/research-results/2016/comparing-two-ways-manage-symptoms-patients-who-have-chronic-migraine-and-frequent-medication-use-mots-trial

  Chronic migraine is when people have headaches 15 or more days per month, with migraines for at least 8 of those days. Patients can take medicines, such as non-steroidal anti-inflammatory medicines and triptans, to relieve symptoms. But about half of people with chronic migraine use these medicines more often than recommended because of the pain and disability the headaches cause. When these medicines are taken too often for more than three months, its called medication overuse. Medication overuse can lead to more frequent headaches, migraine attacks, and other serious side effects. […] In this study, the research team compared two approaches to treat adult patients with chronic migraine and medication overuse. […] After 12 weeks, the two approaches worked about the same to reduce the number of days with a migraine.

• #23 Comparing Two Ways to Manage Symptoms for Patients Who Have Chronic Migraine and Frequent Medication Use — The MOTS Trial | PCORI

  https://www.pcori.org/research-results/2016/comparing-two-ways-manage-symptoms-patients-who-have-chronic-migraine-and-frequent-medication-use-mots-trial

  Compared with patients who continued to take the overused medication, patients who switched to a different medication had fewer days on which they used medication to treat symptoms and were less likely to be in a medication overuse pattern during weeks 9-12. […] However, switching to another medication may help patients reduce medication overuse. […] Many people with chronic migraines use medication more often than recommended. This overuse can have the undesired effect of more migraines and headaches and other serious side effects. The MOTS (Medication Overuse Treatment Strategy) Trial compared two ways to treat adult patients who have chronic migraine and medication overuse. It found that not switching or limiting medication wasn’t worse than switching medication, according to results published in Neurology. But the study also found that patients who stopped the overused medicine took it to treat symptoms less often than patients who continued it. They were also less likely to overuse migraine medicines.

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

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

  Headache specialists at UT Southwestern Medical Center address medication overuse headaches (MOHs) by bringing together experts from several disciplines who work together to get patients back on track to a pain-free life. […] Specialists at UT Southwestern work with each MOH patient to identify the cause and create a strategy for successful treatment. […] Most treatment of MOH involves one or more of the following steps: […] Stopping the Medications That Cause MOH […] Bridge therapy, such as a short course of corticosteroids or other medications, can be used on an outpatient basis. […] Discontinuing daily narcotics, opioids, and barbiturates can cause physical withdrawal, so these drugs should not be stopped abruptly. […] Starting a preventive medication while eliminating the overused medications often leads to more rapid control of headaches overall. […] Cognitive behavioral therapy, stress-reduction techniques, lifestyle modifications, and treatment for underlying anxiety and depression are often helpful in combination with other treatment strategies.

• #25 How to prevent and treat medication overuse headaches

  https://www.singlecare.com/blog/medication-overuse-headache/

  Some common bridge therapy options include: Physical therapy: This type of therapy can help to manage pain and improve mobilityespecially for certain types of migraine. […] Biofeedback: This technique teaches people how to control bodily processes like breathing and muscle tension. Biofeedback can reduce headache frequency by 45% to 60% in people with migraine and tension-type headaches. […] Transcutaneous electrical nerve stimulation (TENS): TENS delivers low-voltage electrical currents to stimulate nerves and help bring pain relief. Research shows it can significantly reduce the number of days per month users have headaches. […] Use of non-analgesic medications to control symptoms: Prescription drugs such as alpha and beta blockers, blood pressure medications, and antidepressants may be used to ease the symptoms of medication withdrawal in some cases. […] Treatment of medication overuse headaches may involve trying newer drugs less likely to cause rebound headaches and nondrug therapies that can bring pain relief.

• #26 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 transitional medication is used to treat headaches that occur after stopping the overused medication, to help prevent headache symptoms of withdrawal. […] After medication overuse disorder has been treated, people are instructed to limit their use of all rescue and transitional headache medications used to stop (abort) headaches. […] Medications used to prevent headaches should be continued as prescribed. […] Biofeedback and other cognitive techniques (such as relaxation training, hypnosis, and stress management) can help people control, reduce, or cope with their headaches by changing the way they focus their attention. […] People are counseled to avoid using previously overused medications. They are also taught and encouraged to adopt healthy lifestyle habits.

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

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

  This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary. […] For medication overuse headaches, some questions to ask include: […] Until your appointment, take only as much of your medicine as often as your healthcare professional tells you to. And take care of yourself. Healthy lifestyle habits can help prevent headaches. Get enough sleep, eat plenty of fruits and vegetables, and get regular exercise. Stay away from known headache triggers.

• #28 What Are Medication Overuse Headaches? | Right as Rain

  https://rightasrain.uwmedicine.org/well/health/medication-overuse-headaches

  There are several lifestyle changes that help reduce the onset of headaches, such as good sleep hygiene, daily exercise, good nutrition and limiting stress. Behavioral therapy, physical therapy and relaxation aids like massage and acupuncture can also help. […] Preventive treatments can reduce the number of migraines you have by stopping migraines from occurring in the first place (without causing medication overuse headaches). […] Neuromodulation devices allow you to be self-reliant and access treatment in the luxury of your own home. […] By supplementing over-the-counter pain medication with preventive treatment (or moving to just preventive treatment) you can work with your doctor toward being headache and pain free.

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

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

  Medication overuse headache is a chronic headache that occurs 15 days/month in patients who regularly overuse headache medication for 3 months. Treatment consists of stopping the overused medication, managing withdrawal symptoms, and using other medications to prevent the underlying headache disorder. […] A patient with medication overuse headache can be treated in an outpatient or inpatient setting; sometimes IV medications are required. Patients with headache due to opioid overuse should be treated in an inpatient setting. […] Preventive medications (eg, topiramate, onabotulinumtoxinA, erenumab, epitinezumab, fremanezumab, galcanezumab) are usually started first, and the overused medication is later stopped. […] Cognitive therapy, biofeedback (eg, frontal electromyographic biofeedback), and education are helpful. […] After medication overuse headache has been treated, patients should be instructed to limit acute use of headache medications as follows: Use of previously overused medications is discouraged.

• #30 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. […] The generally accepted treatment is detoxification through withdrawal of the overused medication(s) and the use of bridge therapy to help the patient through the period of withdrawal. This is followed by initiation or reinforcement of prophylactic therapy and is another time for patient education regarding MOH. […] Most patients with MOH can be treated on an outpatient basis. Those using complex combinations of drugs or who have been overusing triptans, opioids, or barbiturates benefit from the in-patient detoxification and supportive care.

• #31

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

  Early start of preventive headache treatment in combination with withdrawal is recommended. The preventive treatment should target the pre-existing headache. If the pre-existing headache diagnosis is too unclear, the start of preventives may be delayed to after withdrawal. […] In line with detailed information, close follow-up and support of patients are essential for succeeding MOH treatment. Most patients relapse into a new MOH within the first year. […] So, to sum up, patients with MOH should start withdrawal therapy, start effective preventive treatment, and be offered close follow-up to prevent relapse. Thank you very much for your attention.

• #32 Medication overuse headache | MedLink Neurology

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

  There are three main strategies to treat medication overuse headache: abrupt discontinuation of the overused medication without preventive therapy, adding preventive therapy without abrupt discontinuation of the overused medication, or adding preventive therapy plus abrupt discontinuation of the overused medication. […] An open-label, randomized clinical trial was conducted at the Danish Headache Center. […] The authors concluded that all three treatment strategies were effective, but withdrawal therapy combined with preventive therapy from the start of withdrawal is recommended as treatment for medication overuse headache. […] The study suggests that when managing chronic migraine with medication overuse, optimizing preventive medication is crucial.

• #32 Medication overuse headache | MedLink Neurology

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

  Medication overuse headache is a chronic headache that occurs in people with a preexisting primary headache, such as migraine or tension-type headache, following overuse of any kind of acute headache medication. In general, treatment of medication overuse headache requires a multidisciplinary setting and includes education of patients, discontinuation of the overused medication, and initiation of preventive treatment. […] The results of the Medication Overuse Treatment Strategy (MOTS) patient-centered randomized trial were published in April 2022 and demonstrated that, for patients with chronic migraine with medication overuse, migraine preventive medication without switching or limiting the acute medication is not inferior to migraine preventive medication with switching to a different acute medication, suggesting optimizing preventive medication is crucial for the treatment of medication overuse headache.

• #33 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) is a type of headache that develops and gets worse with frequent use of any medication treatment for pain in people who have tension-type headache or migraine. […] MOH is a treatable condition and requires that the child affected stops using the medications for the headache to resolve. Abrupt withdrawal of the drugs and starting preventative (prophylactic) therapy (ideally after one to two months from stopping medications) seems to be the best way forward according to clinical data. […] It is important to warn the child or young person and their parents that discontinuing overused medicines may at first lead to worsening of the headache and some withdrawal symptoms. […] However, it is important to persist, as symptoms will improve within two months of stopping all medications.

• #33 Medication overuse headache | Great Ormond Street Hospital

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

  The choice of prophylactic treatment will depend on the underlying primary headache disorder. […] In general, any patient who has frequent headaches or migraine attacks should be considered as a potential candidate for preventive medications instead of being encouraged to take more and more painkillers or other rebound-causing medications. […] Preventive medications are taken on a daily basis.

• #34 Headaches from Medication-Overuse: Withdrawal Symptoms

  https://patient.info/doctor/medication-overuse-headache-and-headache-triggers

  MOHs are the most common type of headache after tension-type headache and migraine. […] Medication-overuse headache is defined as: Headache present on at least 15 days per month. […] It usually, but not always, resolves after the over-used medication is stopped. […] Treatment is based on education, support, withdrawal treatment (detoxification), and prophylactic treatment. […] Complete withdrawal of medication causes rebound worsening of headache. […] Once the MOH has ceased then regular, preventative treatment for headache may be commenced if needed and appropriate. […] Prophylactic agents which may be effective for frequent headaches persisting after the overused medication has been withdrawn: Prednisolone, naratriptan, amitriptyline, sodium valproate, gabapentin, topiramate and propranolol have been shown to be effective in patients abruptly withdrawing symptomatic medication.

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

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

  Medication overuse headache (MOH) is a chronic secondary headache condition attributable to overuse of acute medication(s) by an individual with a preexisting primary headache disorder (almost always migraine or tension-type headache). Patients with MOH suffer from a headache on more days than not. […] Education and advice is the first step in managing MOH and may be sufficient on its own to resolve the condition. Withdrawal from the acute medication may be abrupt or tapered, depending on the class of medication that is overused. Symptomatic treatment for withdrawal symptoms may be needed. […] Initiation of a preventive regimen that targets the underlying headache disorder is typically used to facilitate withdrawal from the overused medication. For patients with underlying migraine, the recommended options are topiramate, onabotulinumtoxinA, or calcitonin gene-related peptide (CGRP) antagonists. For those with underlying tension-type headache, amitriptyline is most commonly used. […] Inpatient treatment may be necessary for patients who are withdrawing from opioids, barbiturates, or benzodiazepines.

• #36 Addressing Medication Overuse Headache (MOH) in Clinical Practice – Association of Migraine Disorders

  https://www.migrainedisorders.org/medication-overuse-headache-in-clinical-practice/

  Julie reported a significant improvement to 2 headache days per month at her 3-month follow-up. Her treatment regimen includes galcanezumab (Emgality) 120 mg SQ monthly for prevention and 100 mg of sumatriptan as needed. She completely stopped her intake of ibuprofen after 3 months of starting preventive medication.

• #36 Addressing Medication Overuse Headache (MOH) in Clinical Practice – Association of Migraine Disorders

  https://www.migrainedisorders.org/medication-overuse-headache-in-clinical-practice/

  Medication overuse headache is characterized by: […] Withdrawal of acute medication with optional preventive treatment 2 months after withdrawal […] Use of preventive medication without withdrawal of acute medication […] Withdrawal of acute medication and use of preventive medication. […] However, the authors recommend the use of preventive medication at the time of withdrawal to treat medication overuse headache. When preventive therapy was initiated at the time of withdrawal, 74.2% of patients reverted to episodic migraine and 96.8% of patients had no evidence of MOH. […] Encouraging clinicians to create a culture of prevention is a crucial step in reducing the burden of medication overuse headache. […] Preventive therapies can be divided into several groups: Pharmacological (the first line) […] It is important for all first-line health care providers in primary care, women’s health, urgent care and emergency rooms, as well as pharmacists, to be informed about MOH and the best available prophylactic pharmacological and non-pharmacological options.

• #37 Medication-Overuse Headache: Update on Management

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

  Once established, treating MOH can be difficult and, understandably, patients often display reluctance to reduce acute pain medication, which they have become reliant on in order to reduce headache burden and improve their level of function. In patients with an established MOH, there are two options: either reduction or complete withdrawal of acute pain medication, with or without a bridging treatment, or the addition of a migraine preventative in parallel; or accepting that acute pain medication reduction is not possible and starting a migraine preventative. […] Preventing the development of an MOH through the education of patients and healthcare professionals remains the most important management strategy. Many patients with chronic headaches are not aware of the concept of MOH. […] Some clinicians may choose to start migraine prevention in parallel to acute medication withdrawal. In the COMOESTAS study, patients were allowed acute medication up to 2 days per week and started migraine prevention in parallel. After 6 months, the monthly headache frequency was reduced by 58% compared to the baseline. A Danish trial concluded that patients receiving early migraine prevention during the withdrawal proceed resulted benefited more quickly. […] The use of novel acute pain therapies for migraines, including Gepants and Ditans, which do not cause MOH, are likely to improve patient outcomes, although they are expensive compared to conventional acute treatments and therefore are not always readily accessible.

• #38 Rebound Headache – Migraine World Summit

  https://migraineworldsummit.com/rebound-headache/

  The recent availability of the gepants offers promise, and already significant success, for prevention and acute treatment of rebound headache, eliminating what could otherwise be a difficult withdrawal period. […] The majority of patients with rebound headache are able to stop using their acute medications which typically breaks the cycle within a few weeks. […] If you suspect you have rebound headache, and are experiencing more than two headaches a week, you will need to partner with your primary physician or headache specialist to officially diagnose and put together a treatment plan.

• #39

  https://bpac.org.nz/bpj/2008/september/overuse.aspx

  Continuing to prescribe more and more analgesics, particularly those with addictive potential, without educating patients about the correct use of medications may promote medication-overuse headache. […] Patient education is important to initiate withdrawal and to reduce the risk of relapse. Encouraging and supporting the patient towards their goals and appropriate follow up is necessary. Behavioral techniques such as relaxation therapies and stress management have been shown to enhance outcome over drug treatment alone.

• #40 What is Medication Overuse Headache and How is it Treated? – Premier Neurology & Wellness Center

  https://premierneurologycenter.com/blog/what-is-medication-overuse-headache-and-how-is-it-treated/

  What is Medication Overuse Headache and How is it Treated? […] Medication Overuse Headache, also known as rebound headache, is a form of chronic headache that occurs when the very medications used to alleviate headache pain end up causing more headaches. […] Treating Medication Overuse Headache: […] The first step is to stop the overused medications entirely. […] Depending on the individual’s headache pattern and medical history, a healthcare provider may prescribe preventive medications to reduce the frequency and intensity of headaches. […] Identifying and addressing lifestyle factors that contribute to headaches can be crucial in managing MOH. […] Complementary therapies like acupuncture, biofeedback, and mindfulness-based stress reduction have shown promise in reducing headache frequency and improving overall well-being.

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

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

  MOH is considered a preventable headache disorder. Risk factors for the development of MOH include female gender, frequent prior headaches, frequent use of analgesic medications, inadequate control of previous headaches, use of benzodiazepines, smoking, physical inactivity, obesity, addictive behavior patterns, psychiatric comorbidities, other painful conditions, and lower socioeconomic status. […] Education about the necessity of discontinuing excessive medication use is effective in the treatment of MOH. In fact, this approach alone led to the transformation of MOH into an episodic headache form in up to 40% of patients. The best strategy for prevention and treatment is education for every patient with headaches, as no completely certain factors for the transformation from episodic headache to MOH have been identified thus far.

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

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

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

• #43 Rebound Headache

  https://mobile.fpnotebook.com/Neuro/Headache/RbndHdch.htm

  Medication Overuse Headache […] Headache on 15 or more days of the month with known preexisting Primary Headache AND […] Regular overuse of abortive Headache medication over 3 months […] Most medications may be stopped abruptly […] Provide non-Opioid rescue medications during withdrawal […] Initiate Headache prophylaxis simultaneously with withdrawal […] Decreases Headache frequency and sustains resolution of Medication Overuse Headaches […] Consider switching from Triptan to Rimegepant or Ubrogepant […] Maximize Migraine Prophylaxis […] Limit acute Migraine Abortive Medications to 10 days per month or 2 days per week […] Long acting NSAIDs may be less likely than other simple Analgesics to cause Rebound Headaches […] Avoid butalbital (fiorinal) for Headaches […] Get control of Migraine Headaches soon after episode onset (e.g. start Triptan at higher, effective dose early)

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

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

  Medication overuse headaches most often go away after stopping the pain medicine. This can make it challenging to manage pain in the short term. But your healthcare professional can help you find ways to prevent medication overuse headaches. […] Talk with your healthcare professional if: […] Contact your healthcare professional if you need headache medicine more than twice a week. […] To help prevent medication overuse headaches: […] Don’t take medicines that have butalbital or opioids if possible. […] Taking care of yourself can help prevent most headaches. […] If you smoke, talk to your healthcare professional about quitting. Smoking is linked to a higher risk of medication overuse headaches. […] Daily doses of caffeine also may add to medication overuse headaches. Caffeine may come from coffee, soda, pain relievers and other products. Read product labels to make sure you’re not getting more caffeine than you know about.

• #45 Medication Overuse Headache | National Headache Foundation

  https://headaches.org/resources/medication-overuse-headache/

  Medication Overuse Headache (MOH), often referred to as rebound headache, is a condition where frequent use of acute headache medications leads to an increase in headache frequency and severity. […] The most important strategy in managing MOH is to identify an effective preventive medication, rather than solely focusing on reducing or eliminating the overused medication. […] Medications like botulinum toxin A (Botox), topiramate, and CGRP monoclonal antibodies (e.g., erenumab) can help reduce headache frequency and may lower the need for acute medication use. […] Gradually taper the use of overused medications rather than stopping abruptly to minimize withdrawal symptoms and anxiety. […] Barbiturates (e.g., butalbital) and narcotics (e.g., oxycodone, hydrocodone) are more likely to cause MOH and are generally best avoided. […] Regular consultations with a healthcare provider can help adjust preventive and acute treatment plans based on response and changes in headache patterns. […] Consult a healthcare provider if you have frequent headaches and find yourself using acute medications more than 10-15 days per month.

• #46 What are rebound headaches? How to break the cycle

  https://www.bswhealth.com/blog/medication-overuse-headaches-how-to-break-the-cycle

  Unfortunately, the only way to stop the vicious cycle is to stop use of the medication and completely eliminate it from use for about six to eight weeks. […] […] It is important to note, however, that although some medications can be stopped cold turkey, others may need to be weaned slowly with a gradual withdrawal or even medication rotation. […] […] We try to decipher the initial headache type and start alternative treatment that does not contribute to rebound. Addressing the underlying problem often makes the transition off frequent acute medications smoother, Dr. Saporito said. […] […] Ultimately, the best way to avoid the cycle of medication overuse headaches is to prevent it by taking medication thoughtfully and tracking your days of use. If at the time of reading this, you have more than 4 headache days per month, you should schedule an appointment with your doctor. […] […] When people need to reach for an as-needed medication more than once per week, it may be time to start a preventative medication. These are aimed to stop the headache from starting in the first place, Dr. Saporito said.

• #47 Medication Overuse Headache – Migraine Canada

  https://migrainecanada.org/posts/the-migraine-tree/branches/acute-treatments/medication-overuse-headache-tips-successful-withdrawal/

  In this post, we delve into the complexities of Medication Overuse Headache. […] Explore implicated medications and discover effective strategies for withdrawal and management. […] Scientific studies show that stopping medication overuse for at least 3 months improves headaches in 60-70% of people. […] Stop the offending medications with your doctors guidance. Daily preventive medications might be necessary. Overuse may block their effects. […] Alternative treatments may be used. Withdrawal can be tough and needs careful planning. […] Preventive medications might be needed for at least 3 months. Rescue medications can be used again but less frequently. […] Yes. Your brain will remain vulnerable. Adhere to safe medication limits to avoid recurrence. […] Medication overuse headache is highly treatable. Your wellness is within your control!

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

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

  The initiation of preventative therapy is a fundamental therapeutic step to prevent episodic headache converting into a chronic condition. […] The question remains unresolved whether starting prophylactic treatment at the beginning of withdrawal or awaiting the effect of detoxification is the most effective approach. […] Comorbidities have important implications for the management of MOH in daily clinical practice. […] Therefore, screening patients for anxiety and depression, is important for clinical outcomes and for trials studying MOH. […] A successful withdrawal leads to a better response for prophylactic treatment, even in patients with little improvement in headache frequency. […] The evidence provided in multiple studies shows that medication overuse causes changes to the CNS in people with an underlying susceptibility for progression. […] Research in MOH is moving forward and is discovering the mechanisms underlying headache progression and medication overuse.

• #49 Medication Overuse Headache, formerly known as Rebound Headache | MHNI Migraine Headache and Head Pain Treatment

  https://www.mhni.com/headache-pain-faq/rebound-headache-moh

  Analgesics (pain killers) are designed to relieve pain, but if these drugs (both prescription and nonprescription) are overused, they can actually cause headaches. […] The best treatment for breaking the rebound (MOH) cycle is to discontinue excessive analgesic usage, which may intensify pain at first but may lead to a dramatic improvement in pain following discontinuance. […] Experience at MHNI has shown that some patients with rebound headache (MOH) must be hospitalized in our special head pain unit or treated in our infusion program to provide an opportunity to carefully discontinue the analgesic, treat the expected increase in headache, attend to the consequence of overuse, and develop an appropriate treatment strategy. Long-term outcome is usually excellent in straightforward cases of rebound (MOH).

• #50 Medication overuse headache: current strategies and unmet needs – VJNeurology

  https://www.vjneurology.com/video/ano1jrry6ae-medication-overuse-headache-current-strategies-and-unmet-needs/

  Morris Levin introduces the concept of medication overuse headache (MOH), a condition in which patients with chronic headache, especially migraine, who overuse acute medications get an increased frequency and severity of headaches, negatively impacting their quality of life. […] Despite some well-conducted studies, the data on the management of MOH is scarce, and experts do not yet agree on how best to approach detoxification and prevention. […] Prof. Levin emphasizes that treatment options for MOH will improve over the coming years as the causes of the condition are better understood. […] The value of switching analgesics in medication overuse headache treatment.

• #51 Migraine Medication Overuse Headache: Treatment, Prevention, and More

  https://www.bezzymigraine.com/discover/managing-mig/health-can-migraine-meds-actually-trigger-an-attack-what-to-know/

  If you think that you have medication adaptation headache, schedule an appointment with your specialist so that you can develop a plan to manage it, Berk says. […] Depending on the severity, youll need to slowly taper off of the acute medication causing this complication and remain off it for several months, Berk adds. […] To prevent rebound headaches, its important to cycle through medications rather than relying on the same one every day. […] General headache prevention is also key for preventing rebound headaches. […] Its important to develop a robust acute toolkit with your provider so that you have multiple acute treatments that wouldnt contribute to adaptation headache, Berk says. […] Ajovy is a medication thats specifically helpful for preventing rebounds. […] The important thing to remember? Rebound headaches are treatable. […] Its important to know that the cycle of medication overuse headache can be broken and reversed, Donnelly says.

• #52 What Should You Know About Rebound Headache and Medication Overuse? — Migraine Again

  https://www.migraineagain.com/rebound-headache/

  This approach has been used recently, with excellent success, with the monoclonal antibodies targeting CGRP. […] Another difference is in withdrawal approaches whether to gradually taper versus stop the medication cold turkey. […] Care must be exercised when stopping the frequent use of barbiturates or butalbital because there is a very small possibility that rapid withdrawal can provoke a seizure. […] Yes. Headache specialists believe that the increased frequency of acute medication use is a risk factor in increased frequency of migraine attacks and transition from episodic to chronic migraine. […] This is a situation where it is helpful for the individual to educate themselves and understand that frequent use of acute medications has the potential to sensitize the system and worsen the headache disorder in the long run.

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