Materiały źródłowe

• #1 How to Treat and Prevent Medication Overuse Headaches

  https://ostrowonline.usc.edu/medication-overuse-headaches/

  Over 1.5% of the population experiences Medication Overuse Headaches (MOH). This type is the most common migraine-like headache. People with MOH experience pain over 15 days each month. MOH ranges higher in women (2.6%) and people over 50 years of age (nearly 5%). […] The second and most viable form of treatment is the discontinuation of overused acute medications. The treatment can involve termination of persistent headaches by use of preventive medications, instruction in appropriate use of abortives, or behavioral therapy to change drug use and habits. […] Finally, there are specific drug use guidelines that are recommended to avoid MOH prior to experiencing pain. These guidelines can also provide insights into other causes of MOH. […] Simple Analgesics taken maximum of 15 days per month […] Opiate (e.g., codeine) taken maximum of 10 days per month […] Triptans taken maximum of 10 days per month.

• #2 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. […] 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. […] Several small studies have emphasized the need for MOH patient education to reduce the incidents of MOH. […] Specific transitional strategies can be used to help discontinue the overused medication and hence reduce MOH.

• #3 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. […] 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. […] 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 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. […] Emerging evidence has detailed that CGRP monoclonal antibodies are efficacious as a preventive treatment method for MOH. […] Overall, the evidence suggests that there should be an emphasis on patient education.

• #4 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.

• #5 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.

• #6 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. […] 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. […] 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 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. […] Emerging evidence has detailed that CGRP monoclonal antibodies are efficacious as a preventive treatment method for MOH. […] Overall, the evidence suggests that there should be an emphasis on patient education.

• #7 Frontiers | Medication overuse headache: a review of current evidence and management strategies

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2023.1194134/full

  Medication overuse headache (MOH) is a common, challenging, and disabling condition that affects millions of people worldwide. MOH occurs when people who suffer from primary headaches, such as migraines or tension-type headaches, use painkillers too frequently or in excessive doses. This paradoxically leads to a worsening of headache frequency and severity. […] The aim of this article is to provide an overview of MOH, including its definition, epidemiology, risk factors, pathophysiology, symptoms, diagnosis, treatment, and prevention. […] Given the high prevalence of migraine and tension-type headaches and the fact that virtually anyone with such a disorder may be at risk of developing MOH, the number of people at risk is substantial. Educational strategies to increase knowledge among health care providers to identify patients at risk, 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.

• #8 Preventing and treating medication overuse headache

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

  Given the high prevalence of migraine and tension-type headache, and the fact that virtually anyone with such a disorder may be at risk of developing MOH, the number of people at risk is substantial. 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. […] Medication overuse headache can be both prevented and treated, but it is not always an easy task.

• #9 Frontiers | Medication overuse headache: a review of current evidence and management strategies

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2023.1194134/full

  Medication overuse headache (MOH) is a common, challenging, and disabling condition that affects millions of people worldwide. MOH occurs when people who suffer from primary headaches, such as migraines or tension-type headaches, use painkillers too frequently or in excessive doses. This paradoxically leads to a worsening of headache frequency and severity. […] The aim of this article is to provide an overview of MOH, including its definition, epidemiology, risk factors, pathophysiology, symptoms, diagnosis, treatment, and prevention. […] Given the high prevalence of migraine and tension-type headaches and the fact that virtually anyone with such a disorder may be at risk of developing MOH, the number of people at risk is substantial. Educational strategies to increase knowledge among health care providers to identify patients at risk, 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.

• #10 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 treatable condition and requires that the child affected stops using the medications for the headache to resolve. […] It is recommended that patients follow the two days a week rule, in essence, not taking any of the painkillers or triptans for more than two days a week. […] 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. Some patients may require preventive medications for many years; others may require them for only a relatively short period of time such as six months. Many medications such as anti-convulsants, antidepressants, anti-hypertensives and antihistamines have been shown to be effective preventive medications.

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

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

  Medication overuse headache (MOH), is a headache that results from the frequent use of acute medicines or painkillers, such as triptans, ergotamines, opiates, non steroidal anti-inflammatory drugs (NSAIDs) and paracetamol. […] Making sure you don’t regularly take painkillers on more than two days a week will reduce your risk of developing MOH. […] The best means of withdrawing the use of these painkillers depends on the types of medicines being used and the person’s general health. […] If people have very frequent migraine attacks a preventive treatment is usually recommended. These can reduce the number of attacks, so that fewer painkillers are needed and reduce the likelihood of medication overuse headache. An effective preventive will usually give better overall control of migraine than painkillers or acute treatments alone.

• #12 How to Treat and Prevent Medication Overuse Headaches

  https://ostrowonline.usc.edu/medication-overuse-headaches/

  Over 1.5% of the population experiences Medication Overuse Headaches (MOH). This type is the most common migraine-like headache. People with MOH experience pain over 15 days each month. MOH ranges higher in women (2.6%) and people over 50 years of age (nearly 5%). […] The second and most viable form of treatment is the discontinuation of overused acute medications. The treatment can involve termination of persistent headaches by use of preventive medications, instruction in appropriate use of abortives, or behavioral therapy to change drug use and habits. […] Finally, there are specific drug use guidelines that are recommended to avoid MOH prior to experiencing pain. These guidelines can also provide insights into other causes of MOH. […] Simple Analgesics taken maximum of 15 days per month […] Opiate (e.g., codeine) taken maximum of 10 days per month […] Triptans taken maximum of 10 days per month.

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

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

  More specifically, limit your use of triptans, ergot alkaloids, and combination analgesics to less than 10 days per month. Aspirin, Tylenol, and NSAIDs should be limited to less than 15 days per month. […] Avoid opioids and butalbital, if possible, and start a preventive headache medication if you are experiencing eight or more headaches days per month.

• #14 How to Treat and Prevent Medication Overuse Headaches

  https://ostrowonline.usc.edu/medication-overuse-headaches/

  Over 1.5% of the population experiences Medication Overuse Headaches (MOH). This type is the most common migraine-like headache. People with MOH experience pain over 15 days each month. MOH ranges higher in women (2.6%) and people over 50 years of age (nearly 5%). […] The second and most viable form of treatment is the discontinuation of overused acute medications. The treatment can involve termination of persistent headaches by use of preventive medications, instruction in appropriate use of abortives, or behavioral therapy to change drug use and habits. […] Finally, there are specific drug use guidelines that are recommended to avoid MOH prior to experiencing pain. These guidelines can also provide insights into other causes of MOH. […] Simple Analgesics taken maximum of 15 days per month […] Opiate (e.g., codeine) taken maximum of 10 days per month […] Triptans taken maximum of 10 days per month.

• #15

  https://step2.medbullets.com/neurology/121606/medication-overuse-headaches

  Secondary headache disorder due to medication overuse in patients with a primary headache disorder (e.g., migraine, tension-type headache) […] also known as rebound headaches […] headaches occur 15 times/month […] medication use 10-15 times/months for 3 months […] all medications used for acute treatment of primary headache disorder can lead to medication overuse headaches […] Prevention […] education on medication overuse headaches […] headache diary.

• #16 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.

• #17 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. […] European guidelines from 2011, based on publications with a low level of evidence and on expert consensus, state that early discontinuation of overused medications is the first line of management.

• #18 Medication Overuse Headache | American Headache Society

  https://americanheadachesociety.org/resources/primary-care/medication-overuse-headache

  Medication overuse headache (MOH) occurs when a person is regularly overusing acute headache medications, resulting in increased headache. […] Preventive treatments for migraine should be considered for patients with four or more headache days a month. […] Understanding and avoiding medication overuse headache. Learn more about how to prevent and treat medication overuse headache. […] Medication overuse headache is a well-known association with chronic headache disorders including chronic migraine. Dr. Friedman offers guidance on how it can be treated.

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• #21 Medication-Overuse Headache

  https://practicalneurology.com/articles/2021-may/medication-overuse-headache-2

  Treat medication-overuse headache with discontinuation and prevention. […] A general rule of thumb has been to limit use of any acute medications less than 10 days/month to avoid MOH and offer preventive treatment to anyone with migraine or other headache conditions on 10 or more days/month. […] It is essential not to return to use of the precipitating medications. This can be difficult for patients who may be tempted to return to a medication that they once found effective. It is exceedingly hard to limit the use of a medication when someone had free access to it previously. It is far better switch to an alternative class or agent to avoid repeating previous behavior. […] Preliminary evidence suggests that discontinuation with concurrent preventive medication may be the most effective treatment.

• #22 Prevention of migraine attacks – Wikipedia

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

  Preventive migraine medications are considered effective if they reduce the frequency or severity of the migraine attacks by at least 50%. […] Guidelines are fairly consistent in rating the anticonvulsants topiramate and divalproex/sodium valproate, and the beta blockers propranolol and metoprolol as having the highest level of evidence for first-line use for migraine prophylaxis in adults. […] Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. […] A large number of medications with varying modes of action can be used. […] Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next. […] Often preventive medications do not have to be taken indefinitely. Sometimes as little as six months of preventive therapy is enough to „break the headache cycle” and then they can be discontinued.

• #23 Medication overuse headache – Wikipedia

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

  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. Some patients may require preventive medications for many years; others may require them for only a relatively short period of time such as six months. Effective preventive medications have been found to come from many classes of medications including neuronal stabilizing agents (aka anticonvulsants), antidepressants, antihypertensives, and antihistamines. Some effective preventive medications include Elavil (amitriptyline), Depakote (valproate), Topamax (topiramate), and Inderal (propranolol). […] MOH is common and can be treated. The overused medications must be stopped for the patient’s headache to resolve, though there is limited evidence to suggest this can be done without using other preventive measures. Clinical data shows that the treatment of choice is abrupt drugs withdrawal, followed by starting prophylactic therapy. […] MOH can be treated through withdrawal of the overused drug(s) and by means of specific approaches that focus on the development of a close doctor-patient relationship in the post-withdrawal period.

• #24 Three Strategies Are Effective in Managing Patients with Medication Overuse Headaches | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0401/p439a.html

  What are the effective approaches to managing patients with medication overuse headaches? […] In this study, achieving cure from medication overuse headaches after six months was likely regardless of strategy: detoxification (discontinuation of analgesic) plus pharmacologic prophylaxis, pharmacologic prophylaxis without withdrawal, or detoxification with pharmacologic preventive therapy delayed for two months. […] Although the authors favor the combined strategy, it seems like this is a good time for shared decision-making. […] The following prophylactic agents were ultimately used: metoprolol, lisinopril, candesartan (Atacand), topiramate (Topamax), amitriptyline, mirtazapine (Remeron), and onabotulinumtoxinA (Botox). […] More than a 20% drop-out rate is worrisome. […] Although the presentation of their data is confusing, the authors report that medication overuse headaches were cured in 97% of those completing the detoxification plus pharmacologic prophylaxis strategy compared with 74% of those completing the pharmacologic preventive strategy and 89% of those completing the detoxification strategy. […] Each strategy appeared to be highly effective, but the unmasked design, loose medication management, and spotty drop-out rates raise some concerns about the data.

• #25 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. […] Frequent or daily use of medications to treat acute headaches can increase headache frequency and cause episodic headaches to become chronic. […] A patient with medication overuse headache can be treated in an outpatient or inpatient setting; sometimes IV medications are required. […] Preventive medications (eg, topiramate, onabotulinumtoxinA, erenumab, epitinezumab, fremanezumab, galcanezumab) are usually started first, and the overused medication is later stopped. […] After medication overuse headache has been treated, patients should be instructed to limit acute use of headache medications as follows: […] Cognitive therapy, biofeedback (eg, frontal electromyographic biofeedback), and education are helpful. […] Medication overuse headache can be effectively treated to remission in about 50% of patients after 10 years.

• #26 Prevention of migraine attacks – Wikipedia

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

  Preventive migraine medications are considered effective if they reduce the frequency or severity of the migraine attacks by at least 50%. […] Guidelines are fairly consistent in rating the anticonvulsants topiramate and divalproex/sodium valproate, and the beta blockers propranolol and metoprolol as having the highest level of evidence for first-line use for migraine prophylaxis in adults. […] Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. […] A large number of medications with varying modes of action can be used. […] Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next. […] Often preventive medications do not have to be taken indefinitely. Sometimes as little as six months of preventive therapy is enough to „break the headache cycle” and then they can be discontinued.

• #27 Prevention of migraine attacks – Wikipedia

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

  Preventive migraine medications are considered effective if they reduce the frequency or severity of the migraine attacks by at least 50%. […] Guidelines are fairly consistent in rating the anticonvulsants topiramate and divalproex/sodium valproate, and the beta blockers propranolol and metoprolol as having the highest level of evidence for first-line use for migraine prophylaxis in adults. […] Preventive medication has to be taken on a daily basis, usually for a few weeks, before the effectiveness can be determined. […] A large number of medications with varying modes of action can be used. […] Selection of a suitable medication for any particular patient is a matter of trial and error, since the effectiveness of individual medications varies widely from one patient to the next. […] Often preventive medications do not have to be taken indefinitely. Sometimes as little as six months of preventive therapy is enough to „break the headache cycle” and then they can be discontinued.

• #28 Medication-Overuse Headache: Update on Management

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

  Long-term frequent use of acute pain medication for the treatment of headaches has paradoxically been shown to increase the frequency of headaches. So-called medication-overuse headache (MOH) is particularly problematic in patients with migraine who overuse triptans and opioids. Prevention through education remains the most important management strategy. […] Although education remains the most important means of preventing development of MOH, the advent of drugs that target the calcitonin gene-related peptide (CGRP) system for both acute pain relief and prevention of migraines is likely to play an important role in the future management of this disabling headache disorder. […] 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.

• #29 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. […] 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. […] 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 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. […] Emerging evidence has detailed that CGRP monoclonal antibodies are efficacious as a preventive treatment method for MOH. […] Overall, the evidence suggests that there should be an emphasis on patient education.

• #30 Migraine Prevention Med Quilipta Might Stop 'Rebound’ Headaches, Too – Drugs.com MedNews

  https://www.drugs.com/news/migraine-prevention-med-quilipta-might-stop-rebound-headaches-119984.html

  But new research suggests that a medication commonly used to prevent migraines may also help fend off rebound headaches. […] „However, medication overuse can lead to more headaches called rebound headaches, so more preventive treatments are needed.” […] „Based on our findings, treatment with atogepant may potentially decrease the risk of developing rebound headache by reducing the use of pain medications,” Goadsby said in a journal news release. „This could lead to an improved quality of life for those living with migraine.”

• #31

  https://www.kcl.ac.uk/news/migraine-medication-overuse

  New research finds the headache drug, atogepant, is an effective means of decreasing migraine days in adults with chronic migraine. […] The research, published in Neurology, suggests that atogepant can be used as a preventive measure in people overusing acute migraine medications like triptans, ergots and simple analgesics. […] Medication overuse is associated with a higher intensity of headache/migraine pain, and worse pain relief outcomes over a 24 hour period. It can often result in rebound headache once the medication wears off. […] Based on our findings, treatment with atogepant could potentially decrease the risk of developing rebound headache by reducing the use of pain medications, and could lead to an improved quality of life for those living with migraine. […] There is a high prevalence of pain medication overuse among people with migraine as they try to manage what are often debilitating symptoms, however, medication overuse can lead to more headache called rebound headache; this problem is ideally treated by prevention.

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

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

  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. […] According to the study, gepants may be more useful than other acute treatments in patients who have a history of MOH or are at risk of developing it, including those with frequent migraine attacks.

• #33 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. […] 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. […] 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 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. […] Emerging evidence has detailed that CGRP monoclonal antibodies are efficacious as a preventive treatment method for MOH. […] Overall, the evidence suggests that there should be an emphasis on patient education.

• #34 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Behavioral treatments, such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavior therapy, are effective options for migraine prevention. […] Once the need for prophylactic treatment is established, adhering to the following consensus-based principles of care may improve the success of preventive therapy. […] Allow an adequate trial for each treatment. The patient may see improvement in six to eight weeks, but it may take up to six months for full effect. […] Discontinue therapy. If headaches are controlled for at least six to 12 months, consider slowly tapering and discontinuing therapy. […] The complementary treatments petasites, feverfew, magnesium, and riboflavin are probably effective. Nonpharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy also have good evidence to support their use in migraine prevention.

• #35 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Behavioral treatments, such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavior therapy, are effective options for migraine prevention. […] Once the need for prophylactic treatment is established, adhering to the following consensus-based principles of care may improve the success of preventive therapy. […] Allow an adequate trial for each treatment. The patient may see improvement in six to eight weeks, but it may take up to six months for full effect. […] Discontinue therapy. If headaches are controlled for at least six to 12 months, consider slowly tapering and discontinuing therapy. […] The complementary treatments petasites, feverfew, magnesium, and riboflavin are probably effective. Nonpharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy also have good evidence to support their use in migraine prevention.

• #36 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. […] Shots of onabotulinumtoxinA (Botox) may help lower the number of headaches you have each month. They also may make headaches less severe. […] This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary. […] 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.

• #37 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. […] Frequent or daily use of medications to treat acute headaches can increase headache frequency and cause episodic headaches to become chronic. […] A patient with medication overuse headache can be treated in an outpatient or inpatient setting; sometimes IV medications are required. […] Preventive medications (eg, topiramate, onabotulinumtoxinA, erenumab, epitinezumab, fremanezumab, galcanezumab) are usually started first, and the overused medication is later stopped. […] After medication overuse headache has been treated, patients should be instructed to limit acute use of headache medications as follows: […] Cognitive therapy, biofeedback (eg, frontal electromyographic biofeedback), and education are helpful. […] Medication overuse headache can be effectively treated to remission in about 50% of patients after 10 years.

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

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

  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. […] 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. […] The „Raskin protocol” is one such regimen that compared intravenous DHE and metoclopramide every 8 hours versus diazepam in patients with MOH and it demonstrated that DHE was beneficial during the detoxification phase of MOH. […] Adding behavioral therapy to the treatment algorithm can greatly reduce the relapse rates for MOH.

• #39 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. […] Shots of onabotulinumtoxinA (Botox) may help lower the number of headaches you have each month. They also may make headaches less severe. […] This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary. […] 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.

• #40 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. […] Shots of onabotulinumtoxinA (Botox) may help lower the number of headaches you have each month. They also may make headaches less severe. […] This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary. […] 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.

• #41 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. […] Shots of onabotulinumtoxinA (Botox) may help lower the number of headaches you have each month. They also may make headaches less severe. […] This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary. […] 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.

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

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

  What you do need is preventive treatments to reduce the number of days per month you have headaches (which in turn reduces how often you need medication for symptom management and therefore stops medication overuse). […] There are several lifestyle changes that help reduce the onset of headaches, such as good sleep hygiene, daily exercise, good nutrition and limiting stress. […] 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.

• #43 Medication overuse headaches | Beacon Health System

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

  If you smoke, talk to your healthcare professional about quitting. Smoking is linked to a higher risk of medication overuse headaches. […] 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.

• #44 Migraine Headache Prophylaxis | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0101/p17.html

  Behavioral treatments, such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic biofeedback, and cognitive behavior therapy, are effective options for migraine prevention. […] Once the need for prophylactic treatment is established, adhering to the following consensus-based principles of care may improve the success of preventive therapy. […] Allow an adequate trial for each treatment. The patient may see improvement in six to eight weeks, but it may take up to six months for full effect. […] Discontinue therapy. If headaches are controlled for at least six to 12 months, consider slowly tapering and discontinuing therapy. […] The complementary treatments petasites, feverfew, magnesium, and riboflavin are probably effective. Nonpharmacologic therapies such as relaxation training, thermal biofeedback combined with relaxation training, electromyographic feedback, and cognitive behavior therapy also have good evidence to support their use in migraine prevention.

• #45 Medication Overuse Headache | New York Headache Center

  https://nyheadache.com/educational-materials/medication-overuse-headache/

  Medication overuse headache (MOH) is a chronic daily headache caused by the use of too much acute medication. It generally occurs in people with migraine or tension-type headaches who take drugs too often. […] The best way of treating MOH is to stop or wean off the offending medication under the guidance of your doctor. […] Non-drug therapy also plays a role in the treatment of MOH. Acupuncture, biofeedback, meditation or relaxation training and cognitive-behavioral therapy can be very effective, particularly when used in conjunction with medications.

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

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

  What you do need is preventive treatments to reduce the number of days per month you have headaches (which in turn reduces how often you need medication for symptom management and therefore stops medication overuse). […] There are several lifestyle changes that help reduce the onset of headaches, such as good sleep hygiene, daily exercise, good nutrition and limiting stress. […] 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.

• #47 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/

  Preventives are typically taken every day and have fewer side effects and a lower chance of withdrawal than acute treatments. […] 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 other strategies to prevent rebounds include: taking fremanezumab (Ajovy), alternating acute medications, using a neuromodulation device. […] Ajovy is a medication thats specifically helpful for preventing rebounds. […] A 2020 study suggests that using a remote electrical neuromodulation device along with standard migraine care could reduce the use of acute migraine medications and, therefore, lower the risk of medication overuse headaches. […] Its important to know that the cycle of medication overuse headache can be broken and reversed.

• #48 Combination Therapies Show Highest Efficacy Against Medication-Overuse Headache – Neurology Advisor

  https://www.neurologyadvisor.com/news/combination-therapies-medication-overuse-headache/

  Combination therapies showed greater efficacy than abrupt withdrawal alone in the management of patients with medication-overuse headache. […] Combination therapies appear effective as first-line treatment in medication-overuse headache (MOH) and may help reduce relapse risk, according to study results published in The Journal of Headache and Pain. […] Combination therapies demonstrated the highest efficacy in the management of MOH when compared with control interventions. […] MOH management decisions should consider not only efficacy but also patient preferences, tolerability, comorbidities, contraindications, and costs. […] The use of abrupt withdrawal alone showed no significant efficacy relative to control interventions. […] However, the addition of either single oral preventive therapy or GONB was associated with significant improvement, reducing monthly headache frequency.

• #49 Three Strategies Are Effective in Managing Patients with Medication Overuse Headaches | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0401/p439a.html

  What are the effective approaches to managing patients with medication overuse headaches? […] In this study, achieving cure from medication overuse headaches after six months was likely regardless of strategy: detoxification (discontinuation of analgesic) plus pharmacologic prophylaxis, pharmacologic prophylaxis without withdrawal, or detoxification with pharmacologic preventive therapy delayed for two months. […] Although the authors favor the combined strategy, it seems like this is a good time for shared decision-making. […] The following prophylactic agents were ultimately used: metoprolol, lisinopril, candesartan (Atacand), topiramate (Topamax), amitriptyline, mirtazapine (Remeron), and onabotulinumtoxinA (Botox). […] More than a 20% drop-out rate is worrisome. […] Although the presentation of their data is confusing, the authors report that medication overuse headaches were cured in 97% of those completing the detoxification plus pharmacologic prophylaxis strategy compared with 74% of those completing the pharmacologic preventive strategy and 89% of those completing the detoxification strategy. […] Each strategy appeared to be highly effective, but the unmasked design, loose medication management, and spotty drop-out rates raise some concerns about the data.

• #50 Treating rebound headaches with early preventative meds best choice, study finds

  https://www.wral.com/story/treating-rebound-headaches-with-early-preventative-meds-best-choice-study-finds/19114513/

  Withdrawal therapy is currently the only treatment for this disorder, sometimes combined with physical or behavioral therapy and preventative medicine treatments, sometimes called „bridge therapies.” […] Those preventative medicine treatments include anticonvulsants, antidepressants, beta blockers and calcium channel blockers that might help control withdrawal pain without risking medication overuse headaches. […] While all three treatments were effective in reducing MOH, the largest reductions in headache and migraine days, days with short-term medication use and days with headache pain intensity were seen in the withdrawal plus preventive medicine group. […] In addition, people who withdrew from meds with the help of preventatives had a significantly higher chance of being cured of their medication overuse headaches than patients who used preventatives or withdrawal alone.

• #51 Treating rebound headaches with early preventative meds best choice, study finds

  https://www.wral.com/story/treating-rebound-headaches-with-early-preventative-meds-best-choice-study-finds/19114513/

  Withdrawal therapy is currently the only treatment for this disorder, sometimes combined with physical or behavioral therapy and preventative medicine treatments, sometimes called „bridge therapies.” […] Those preventative medicine treatments include anticonvulsants, antidepressants, beta blockers and calcium channel blockers that might help control withdrawal pain without risking medication overuse headaches. […] While all three treatments were effective in reducing MOH, the largest reductions in headache and migraine days, days with short-term medication use and days with headache pain intensity were seen in the withdrawal plus preventive medicine group. […] In addition, people who withdrew from meds with the help of preventatives had a significantly higher chance of being cured of their medication overuse headaches than patients who used preventatives or withdrawal alone.

• #52 Treating rebound headaches with early preventative meds best choice, study finds

  https://www.wral.com/story/treating-rebound-headaches-with-early-preventative-meds-best-choice-study-finds/19114513/

  Withdrawal therapy is currently the only treatment for this disorder, sometimes combined with physical or behavioral therapy and preventative medicine treatments, sometimes called „bridge therapies.” […] Those preventative medicine treatments include anticonvulsants, antidepressants, beta blockers and calcium channel blockers that might help control withdrawal pain without risking medication overuse headaches. […] While all three treatments were effective in reducing MOH, the largest reductions in headache and migraine days, days with short-term medication use and days with headache pain intensity were seen in the withdrawal plus preventive medicine group. […] In addition, people who withdrew from meds with the help of preventatives had a significantly higher chance of being cured of their medication overuse headaches than patients who used preventatives or withdrawal alone.

• #53 Treating rebound headaches with early preventative meds best choice, study finds

  https://www.wral.com/story/treating-rebound-headaches-with-early-preventative-meds-best-choice-study-finds/19114513/

  We now recommend withdrawal and early start of preventive treatment. […] Having good medical evidence to support the common practice of both stopping the offending agent or agents, and starting a patient on prevention medication right away, will clear up some of the controversy and confusion. […] Prior studies have found that when patients feel their actions exert control over their headaches, it can help them from overusing medications in the future. […] Patients who withdraw completely experience that a headache can disappear by itself, and that experience is important when talking about preventing relapse into a new medication overuse.

• #54 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. […] Shots of onabotulinumtoxinA (Botox) may help lower the number of headaches you have each month. They also may make headaches less severe. […] This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary. […] 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.

• #55 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. […] Shots of onabotulinumtoxinA (Botox) may help lower the number of headaches you have each month. They also may make headaches less severe. […] This talk therapy teaches ways to cope with headaches. In CBT, you also work on healthy lifestyle habits and keep a headache diary. […] 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.

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

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

  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. […] 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. […] The „Raskin protocol” is one such regimen that compared intravenous DHE and metoclopramide every 8 hours versus diazepam in patients with MOH and it demonstrated that DHE was beneficial during the detoxification phase of MOH. […] Adding behavioral therapy to the treatment algorithm can greatly reduce the relapse rates for MOH.

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

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

  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. […] 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. […] The „Raskin protocol” is one such regimen that compared intravenous DHE and metoclopramide every 8 hours versus diazepam in patients with MOH and it demonstrated that DHE was beneficial during the detoxification phase of MOH. […] Adding behavioral therapy to the treatment algorithm can greatly reduce the relapse rates for MOH.

• #58 Medication overuse headache: strategies for prevention and treatment using a multidisciplinary approach | HKMJ

  https://www.hkmj.org/abstracts/v24n6/617.htm

  Prevention of headaches is better than curing them. Pharmacists and GPs who are aware of MOH can detect patients with increasing frequencies of headaches and medication use. Strategies to assist such patients before they progress into frank MOH include lifestyle adjustments and appropriate prophylaxis, as discussed below as part of MOH treatment. […] Complete withdrawal from overused headache medications is a key component of the management strategy, along with education, counselling, and support. […] A multidisciplinary approach involving primary care physicians (GPs), community pharmacists, nurses, and allied health providers, with referral to neurologists/headache specialists (where available) for complex cases, is recommended.

• #59 Medication overuse headache: strategies for prevention and treatment using a multidisciplinary approach | HKMJ

  https://www.hkmj.org/abstracts/v24n6/617.htm

  Prevention of headaches is better than curing them. Pharmacists and GPs who are aware of MOH can detect patients with increasing frequencies of headaches and medication use. Strategies to assist such patients before they progress into frank MOH include lifestyle adjustments and appropriate prophylaxis, as discussed below as part of MOH treatment. […] Complete withdrawal from overused headache medications is a key component of the management strategy, along with education, counselling, and support. […] A multidisciplinary approach involving primary care physicians (GPs), community pharmacists, nurses, and allied health providers, with referral to neurologists/headache specialists (where available) for complex cases, is recommended.

• #60 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

  Primary care is the best setting for prevention and initial treatment of MOH, since most MOH patients consult their general practitioner (GP) for headache (80%). […] Despite the large controversies about whether medication overuse should be regarded as a cause or a consequence of headache chronification, to date, the worldwide consensus agrees that (ideally complete) withdrawal of acute painkilling drugs is the approach of choice for the acute management of MOH patients. […] The initiation of preventative therapy is a fundamental therapeutic step to prevent episodic headache converting into a chronic condition. […] Comorbidities have important implications for the management of MOH in daily clinical practice. […] A successful withdrawal leads to a better response for prophylactic treatment, even in patients with little improvement in headache frequency.

• #61 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

  Primary care is the best setting for prevention and initial treatment of MOH, since most MOH patients consult their general practitioner (GP) for headache (80%). […] Despite the large controversies about whether medication overuse should be regarded as a cause or a consequence of headache chronification, to date, the worldwide consensus agrees that (ideally complete) withdrawal of acute painkilling drugs is the approach of choice for the acute management of MOH patients. […] The initiation of preventative therapy is a fundamental therapeutic step to prevent episodic headache converting into a chronic condition. […] Comorbidities have important implications for the management of MOH in daily clinical practice. […] A successful withdrawal leads to a better response for prophylactic treatment, even in patients with little improvement in headache frequency.

• #62 Treating Medication Overuse Headache: Opportunities for Improvement

  https://www.neurologylive.com/view/treating-medication-overuse-headache-opportunities-for-improvement

  In a multicenter German study of 182 patients with migraine with frequent use of triptans or analgesics, investigators found both a home-based cognitive behavior therapy program and an educational brochure to be effective in preventing MOH in all participants. […] The management of comorbidities is an important component of care for individuals with MOH. Often when patients have MOH, they have other comorbid conditions like anxiety and insomnia that need to be addressed, Ailani said. […] Emerging findings indicate that the small molecule CGRP receptor antagonists (gepants) may not cause MOH. […] Ultimately, the identification of proper prophylaxis should be driven by clinical history, comorbidity, contraindications and [adverse] effects of the possible drugs, wrote Vandenbussche et al in a 2018 review published in the Journal of Headache and Pain.

• #63 Frontiers | Medication overuse headache: a review of current evidence and management strategies

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2023.1194134/full

  In general, MOH prevention can be either primary or secondary. Primary prevention techniques are critical for preventing MOH from occurring in the first place. Identifying patients at risk and educating them on the risk of MOH and recommended headache management strategies, optimizing abortive and preventive management of patients with chronic headache disorders, and addressing modifiable risk factors such as smoking, physical inactivity, and tranquilizer use are some examples. […] Secondary prevention techniques are critical for detecting the condition early and halting its progression. This can be accomplished by limiting headache symptomatic medication use to no more than 2 days per week and avoiding previously overused medication classes. […] Follow-up therapy with a primary care physician is essential to reduce the risk of relapse. Primary care patient education is a good setting for MOH prevention. Patients should be warned about the risks of improper painkiller use at the time of presentation and during follow-up.

• #64 Frontiers | Medication overuse headache: a review of current evidence and management strategies

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2023.1194134/full

  In general, MOH prevention can be either primary or secondary. Primary prevention techniques are critical for preventing MOH from occurring in the first place. Identifying patients at risk and educating them on the risk of MOH and recommended headache management strategies, optimizing abortive and preventive management of patients with chronic headache disorders, and addressing modifiable risk factors such as smoking, physical inactivity, and tranquilizer use are some examples. […] Secondary prevention techniques are critical for detecting the condition early and halting its progression. This can be accomplished by limiting headache symptomatic medication use to no more than 2 days per week and avoiding previously overused medication classes. […] Follow-up therapy with a primary care physician is essential to reduce the risk of relapse. Primary care patient education is a good setting for MOH prevention. Patients should be warned about the risks of improper painkiller use at the time of presentation and during follow-up.

• #65 Frontiers | Medication overuse headache: a review of current evidence and management strategies

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2023.1194134/full

  In general, MOH prevention can be either primary or secondary. Primary prevention techniques are critical for preventing MOH from occurring in the first place. Identifying patients at risk and educating them on the risk of MOH and recommended headache management strategies, optimizing abortive and preventive management of patients with chronic headache disorders, and addressing modifiable risk factors such as smoking, physical inactivity, and tranquilizer use are some examples. […] Secondary prevention techniques are critical for detecting the condition early and halting its progression. This can be accomplished by limiting headache symptomatic medication use to no more than 2 days per week and avoiding previously overused medication classes. […] Follow-up therapy with a primary care physician is essential to reduce the risk of relapse. Primary care patient education is a good setting for MOH prevention. Patients should be warned about the risks of improper painkiller use at the time of presentation and during follow-up.

• #66 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). […] Experts do not yet fully understand how some headaches become chronic. However, research suggests overusing some medication increases the risk of episodic migraine becoming chronic. […] According to a 2021 review, 3 in 4 people with chronic migraine report overusing headache medication. […] Overusing pain relief medication can cause episodic migraine to turn into chronic migraine. Certain medications may be more likely to cause MOHs. […] 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.

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

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

  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. […] According to the study, gepants may be more useful than other acute treatments in patients who have a history of MOH or are at risk of developing it, including those with frequent migraine attacks.

• #68 Frontiers | Medication overuse headache: a review of current evidence and management strategies

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2023.1194134/full

  In general, MOH prevention can be either primary or secondary. Primary prevention techniques are critical for preventing MOH from occurring in the first place. Identifying patients at risk and educating them on the risk of MOH and recommended headache management strategies, optimizing abortive and preventive management of patients with chronic headache disorders, and addressing modifiable risk factors such as smoking, physical inactivity, and tranquilizer use are some examples. […] Secondary prevention techniques are critical for detecting the condition early and halting its progression. This can be accomplished by limiting headache symptomatic medication use to no more than 2 days per week and avoiding previously overused medication classes. […] Follow-up therapy with a primary care physician is essential to reduce the risk of relapse. Primary care patient education is a good setting for MOH prevention. Patients should be warned about the risks of improper painkiller use at the time of presentation and during follow-up.

• #69 Frontiers | Medication overuse headache: a review of current evidence and management strategies

  https://www.frontiersin.org/journals/pain-research/articles/10.3389/fpain.2023.1194134/full

  In general, MOH prevention can be either primary or secondary. Primary prevention techniques are critical for preventing MOH from occurring in the first place. Identifying patients at risk and educating them on the risk of MOH and recommended headache management strategies, optimizing abortive and preventive management of patients with chronic headache disorders, and addressing modifiable risk factors such as smoking, physical inactivity, and tranquilizer use are some examples. […] Secondary prevention techniques are critical for detecting the condition early and halting its progression. This can be accomplished by limiting headache symptomatic medication use to no more than 2 days per week and avoiding previously overused medication classes. […] Follow-up therapy with a primary care physician is essential to reduce the risk of relapse. Primary care patient education is a good setting for MOH prevention. Patients should be warned about the risks of improper painkiller use at the time of presentation and during follow-up.

• #70 Headaches from Medication-Overuse: Withdrawal Symptoms

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

  The European Federation of Neurological Societies (EFNS) recommends commencing prophylactic drug treatment at the first day of withdrawal therapy or even before. […] After withdrawal therapy patients should be followed up regularly to support their continued headache management and prevent relapse of medication overuse.

• #71 Medication-Overuse Headache: Update on Management

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

  Ideally, patients with frequent headaches should be warned about the potential risks associated with the increased use of acute medications before the development of an MOH. […] 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. […] Brief interventions to educate patients about MOH have been studied in different settings, including the general population, primary care, and dedicated headache centers. In each case, educational intervention has been shown to significantly reduce acute painkiller usage compared to baseline, resulting in a significant reduction in headache frequency.

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