Medication Overuse Headache (MOH)
Alternate terms for MOH, besides rebound headache, include drug-induced, and analgesic-dependent headache. There is on-going debate about whether medication overuse is a cause or consequence of chronic daily headache.
Analgesics (prescription or over-the-counter medications) are often used to control pain including migraine and other types of headaches. When overused, these analgesics can have the opposite effect and actually help perpetuate the headache process. The headache “rebounds” as the last dose wears off, leading the sufferer to take more and more pills. The patient develops a tolerance to pain relievers and needs more medication to get the same level of pain relief. In U.S. headache clinics, up to 80% of patients with chronic daily headache overuse pain medications.
Medication Overuse Headache: Symptoms
- Daily or near daily headache present upon waking
- Headaches that vary in severity and location
- Lower threshold for pain
- Nausea, restlessness, anxiety, irritability, insomnia, depression, difficulty concentrating
- Need to take more and more medication to be effective
Medication Overuse Headache: Diagnosis
Patients with medication Overuse Headache (MOH) typically take headache-relieving medication daily or near daily, but prolonged use of these medications more than three days per week is probably enough to develop drug rebound headache. Tracking times of medications, withdrawal, and headache, using a headache diary, is usually very helpful in diagnosis. The agents most commonly reported to cause drug rebound headache are narcotics, butalalbital products, and combination products containing caffeine.
Medication Overuse Headache: Treatment
The first step in dealing with MOH is to stop the daily use of analgesics: butabarbital (Fiorinal/ Esgic/ Bellergal), narcotics, tranquilizers/ muscle relaxers, caffeine, ergot preparations, and Tylenol. The acute withdrawal of the drugs does exacerbate the headache, but your neurologist can work with you to develop a transitional therapy to help minimize or alleviate withdrawal symptoms.
The goal of withdrawal is to eliminate daily or near-daily medication use and its associated symptoms, to restore an episodic pattern of headache, and to establish an effective treatment strategy including both preventive and acute medications.
Up to 75 percent of patients improve when drug overuse is discontinued and minor analgesics are used with preventive measures.
Medication Overuse Headache: Resources
NIH Neurological Institute
P.O. Box 5801
Bethesda, MD 20824
Voice: (800) 352-9424 or (301) 496-5751
TTY (for people using adaptive equipment): (301) 468-5981