Medication Overuse Headache AKA Medication Adaptation Headache
By: Brooklyn A. Bradley, BS; Medically edited by Dr. Deena Kuruvilla, MD
Medication overuse headache (MOH), also known as medication adaptation headache, is a common neurological disorder that has a major role in the transformation from episodic to chronic headache disorders [1]. MOH is also known as analgesic rebound headache, drug-induced headache, or medication adaptation headache. In today’s blog post, we will discuss causes, symptoms, and treatment.
MOH develops in people with an established primary headache disorder (i.e., migraine, or tension-type headache) who increase the frequency and dosage of their as-needed medication in an attempt to lessen the debilitating symptoms of their primary headache disorder [1]. While each medication class has their own specific threshold, the use of triptans, ergot alkaloids, combination analgesics, or opioids on ten or more days per month is defined as medication overuse [2]. When medication overuse is prolonged, it can unfortunately lead to increased headache frequency, even though the medication is originally indicated for the treatment of the primary headache disorder [1]. People who take analgesics to manage other conditions are also at risk to develop MOH. MOH has been identified as an important risk factor for when primary headaches become more frequent [3].
In people with MOH, headaches may occur daily or nearly daily, in addition to nausea, irritability, mood changes, and difficulty concentrating [4]. The location, character, severity, and duration of MOH can vary from person to person; however, it is usually present upon awakening [2]. Some other symptoms include restlessness and memory problems [2].
There are several treatments available for people with MOH. First, MOH can be considered a preventable disease, so it is important for your doctor to provide education on the importance of preventive treatments so that as needed medications can be used in a limited fashion [1]. Some examples of preventive treatments include blood pressure medications (i.e., propranolol), seizure medications (i.e., topiramate), antidepressants (i.e., amitriptyline, nortriptyline), BOTOX®, and CGRP-blocking medications (i.e., Nurtec, Qulipta). Second, when the overused medication is stopped, preventive therapy can be optimized, and a different as needed medication can be used for less than or equal to 2 days per week [1]. A combination of pharmacological therapy, non-pharmacological therapy, and biofeedback can be used for improvement in a person’s symptoms [2]. When the overused medication is discontinued, it is possible that headaches worsen. However, once the withdrawal period is over, the headaches improve [2].
In conclusion, MOH is a debilitating condition and can result from frequent use of as needed medications. Treatment approaches may require pharmacological and non-pharmacological interventions to break the MOH cycle. If you find that you are using your as needed medications 4 or more days a month, your doctor may discuss with you adding a preventive treatment.
References:
- Fischer MA, Jan A (2023) Medication-Overuse Headache. In: StatPearls. StatPearls Publishing, Treasure Island (FL)
- Headache from Medication Overuse | AMF. In: American Migraine Foundation. https://americanmigrainefoundation.org/resource-library/medication-overuse/. Accessed 23 Aug 2023
- Vandenbussche N, Laterza D, Lisicki M, et al (2018) Medication-overuse headache: a widely recognized entity amidst ongoing debate. The Journal of Headache and Pain 19:50. https://doi.org/10.1186/s10194-018-0875-x
- Medication Overuse Headache – Neurologic Disorders. In: Merck Manuals Professional Edition. https://www.merckmanuals.com/professional/neurologic-disorders/headache/medication-overuse-headache. Accessed 23 Aug 2023