Medication Overuse Headache (MOH)

What is Medication overuse headache?
Are you aware that frequent use of over-the-counter medications can worsen your headaches and migraine? This is a prevalent issue in clinical practice, often unaware to many patients. If you find yourself relying on rescue medications too frequently, it could complicate the accurate diagnosis of your underlying headache. Frequent medication use may lead to atypical headache presentations. The information below aims to provide a better understanding of this headache diagnosis.

Medication overuse headache (MOH), also known as rebound headache, is a condition where frequent use of pain medications to relieve headaches can lead to the worsening of the headaches. This is an official diagnosis! The medications that are commonly associated with MOH include over-the-counter pain relievers like acetaminophen, aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, and prescription medications containing opioids or combination drugs.
The exact mechanism of how MOH develops is not fully understood, but it is believed that regular use of pain medications can lead to changes in the brain and the nervous system, making them less effective over time. As a result, individuals may experience more frequent and severe headaches, creating a cycle of medication use and worsening headaches.

Below is a description and the diagnostic criteria and description of MOH from the ICHD-3:

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.

Diagnostic criteria:

1. Headache occurring on ≥15 days/month in a patient with a pre-existing headache disorder
2. Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache
3. Not better accounted for by another ICHD-3 diagnosis.

Common symptoms of medication overuse headache include:

1. Increased headache frequency: Headaches become more frequent, occurring on most days.
2. Worsening headache intensity: The headaches become more severe and disabling.
3. Dependency on medication: The individual feels the need to use medications more frequently to control the headaches.
4. Pain relief followed by headache recurrence: After the medication wears off, headaches return, prompting more medication use.

Managing Medication overuse headache

Managing MOH typically involves breaking the cycle of medication overuse. This often requires a healthcare professional's guidance and may involve:

1. Medication withdrawal: Gradual discontinuation of the overused medications under the supervision of a healthcare provider.
2. Preventive medications: Introducing medications to prevent headaches, often under the guidance of a neurologist or headache specialist.
3. Lifestyle changes: Identifying and addressing triggers for headaches and adopting lifestyle modifications to manage them.
4. Education: Helping individuals understand the risks of medication overuse and providing strategies for long-term headache management.

Tips to help with MOH

1. Track your over-the-counter and rescue medication use in a diary. How many days of the week do you use them?
2. If you find you are using them too frequently, consider a gradual reduction. It’s generally more preferable to reduce it over time then to stop use immediately. This will help prevent severe headaches.
3. Speak to your specialist or primary care provider about what short-term medication options are available to help with reducing your rescue medication use.
4. Try and treat headaches or migraine attacks that are debilitating or impacting function significantly. For headaches that are not impacting your function, try to treat with rest, hydration, laying in a dark room, or natural remedies such as peppermint oil.

Summary

As a general guideline, healthcare providers recommend using rescue medications only when headaches significantly impact your daily function. Since pain tolerance varies among individuals, treating based on function is an ideal approach. Individuals with Medication Overuse Headache (MOH) can experience significant improvement when gradually reducing rescue medication use. Given the challenges of reducing medication, it's important to consult your healthcare provider for guidance if you're seeking help in this process.

The information provided in this blog is for general informational purposes only and is not intended as medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this blog.

Resources:

1. https://ichd-3.org/8-headache-attributed-to-a-substance-or-its-withdrawal/8-2-medication-overuse-headache-moh/
2. https://www.ncbi.nlm.nih.gov/books/NBK538150/