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Preventing and Treating Medication Overuse Headache

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Medication-Overuse  Headache (MOH) is also known as rebound headache usually occurs when analgesics are taken frequently to relieve headaches. It is the most common chronic headache disorders in the United States and public health problem with a worldwide prevalence of at least 1%. While over-the-counter headache medications can help your pain, they can actually make your headaches worse if the medications are not taken correctly.  

The overuse or misuse of analgesic drugs can occur when the Food and Drug Administration (FDA) labeling instructions are exceeded such as taking the medications three or more days per week or not following your healthcare provider’s advice. Overuse or misuse of these medications can cause “rebound” headaches.

Risk factors

Medication overuse headache is more common in women, with a male to female ratio of 1:3–4. Prevalence is highest around at age 40 to 50 then decreasing thereafter. Associations have been found between MOH and low income and educational levels, perhaps indicating either a cause of the disease or a result of living with a disabling condition. In addition, the literature notes associations between MOH and smoking, sleep disturbances, and high body mass index. Depression and anxiety are more prevalent in patients with MOH than in those with episodic migraine. The risk of developing MOH seems to be greater in persons with a family history of MOH or substance overuse, suggesting some degree of inheritance (social or biological).

 Common immediate relief pain medications are Over the counter drugs (OTC) which are often the culprit of rebound headaches. The list of OTC drugs includes Aspirin, Sinus relief drugs, Acetaminophen, Ibuprofen, Naproxen, and other OTC headache medications.

Other culprits are immediate relief prescription drugs used for the treatment of migraines. The list includes “Triptans” such as Naratriptan, Sumatriptan, Zolmitriptan, Almotriptan, Frovatriptan, and Eletriptan. Butalbitalcombinations are also common culprits. These drugs are safe and effective when taken in small prescribed amounts per week. However, over time, continued regular use can lead to the development of low-grade headaches that just will not go away. Caffeine intake of more than 200mg per day may also increase the risk of rebound headaches. Taking larger or more frequent doses of the immediate-relief medication is not recommended.

Prevention and Treatment

Some methods that can prevent the onset of medication overuse headache include following instructions on how to take medications.
  1. Avoiding regular use of opioid medications and Butalbitalcombination drugs. 
  2. Limiting the use of over the counter or sinus medications to less than 15 days per month, and limiting the use of Triptans to less than 10 days per month.
  3. Alternatives for treatment of migraine include the use of headache preventative (prophylactic) medications that help prevent or reduce the frequency of the headaches. Remember to contact your treating Health care Providers if you need to take over the counter medications for headaches.

References:

Lexicomp accessed 03/10/2020

UpToDate accessed 03/10/2020

Medication-overuse headache, Curr Opin Neurol. 2013 Jun;26(3):276-81. doi: 10.1097/WCO.0b013e328360d596.

Management of medication-overuse headache.

Obermann M, Katsarava Z.Expert Rev Neurother. 2007 Sep; 7(9):1145-55.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741367/#R20

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5741367/#R20

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