Clinical features of medication overuse headache following overuse of different acute symptomatic medications: A preliminary study
Abstract Background Medication overuse headache (MOH) is a growing problem worldwide and is defined as daily or near-daily headache in patients with a primary headache disorder who overuse acute medications. There is debate about whether there are differences in the clinical features and risks of MOH induced by different drugs. Here we investigated the clinical characteristics of patients with MOH following overuse of different acute headache drugs such as triptans and other medications.Methods A multicenter cross-sectional observation study, REgistry for Load and Management of MEdicAtion OveruSE Headache (RELEASE), prospectively collected demographic and clinical data from 114 consecutive patients with MOH according to the International Headache Society criteria between May 2020 and January 2021. We calculated the mean duration until onset of MOH from chronic daily headache (MDMOH), mean monthly frequency of severe headache (MMFSH), mean monthly frequency of seeking medical services (MMFMedS), and mean monthly intake frequency (MMIF) as well as headache impact and neuropsychological tests in patients with MOH after overuse of acute headache drugs.Results A total of 105 eligible MOH patients was included in this study. The patients showed overuse of triptans (31/105, 29.5%), ergotamines (8/105, 7.6%), simple or combination analgesics (37/105, 35.2%), opioids (1/105, 0.9%), and combination of two of more drugs (28/105, 26.7%). The MDMOH was significantly longer for the analgesics group (10.6 years) than the ergotamines (4.1 years), triptans (4.3 years), or multiple drugs group (4.8 years) (p = 0.011, Kruskal–Wallis test). The MMFMedS was lower for the analgesics group (0.37 days per month) than the multiple drugs (0.85 days) or triptans (0.58 days) group (p = 0.008, Kruskal–Wallis test). The MMFSH was significantly lower in the triptans group (7.4 days per month) than in the analgesics (14.4 days) or multiple drugs group (13.7 days) (p = 0.005, Kruskal–Wallis test). The MMIF was higher in the multiple drugs group (25 days per month) than the triptans (18.1 days) or analgesics (19.5 days) group (p = 0.007, Kruskal–Wallis test).Conclusion Data from this prospective multicenter study suggest that the clinical characteristics of MOH depend on the type of overused symptomatic headache medications.