scholarly journals Medication-Overuse Headache: Results from a Pain Medicine Clinic Cohort

2022 ◽  
Author(s):  
Leon Moskatel
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Headache Disorder ◽  
Tension Type Headache ◽  
Pain Clinic ◽  
Secondary Headache ◽  
Pain Medicine ◽  
Medicine Clinic ◽  
Type Headache ◽  
Clinical Records

Background and Objective: Medication-overuse headache (MOH) is a common, disabling, and treatable cause of chronic daily headache. This study evaluates the characteristics of a cohort of patients with MOH seen in a pain medicine clinic. Methods: We conducted a retrospective study of consecutive patients seen by a neurologist in the pain medicine clinic at the University of California, San Diego. Demographics, headache diagnoses, and overused medications were extracted from clinical records from 83 patients ≥ 18 years of age where a diagnosis of MOH was entered into the electronic medical record September 12, 2017-March 30, 2020. Results: Opioids were the most overused medications (42/83, 50.6%) followed by caffeine-containing compounds (20/83, 24.1%), triptans (12/83, 14.5%) and non-steroidal anti-inflammatory drugs (10/83, 12.9%). Chronic migraine was the most common underlying headache syndrome (54/83, 65.1%), followed by secondary headache disorder (13/83, 15.7%) and tension-type headache (8/83, 9.6%). Men were more likely to be overusing opioids (OR 3.3, p = 0.026) while women were more likely to be overusing caffeine-containing compounds (OR 5.4, p = 0.041). Discussion and Conclusions: It is crucial for pain specialists to recognize MOH in the pain clinic setting. Opioid overuse headache is more common among men, likely in part due to migraine being underrecognized in men and therefore men not receiving migraine-specific medications. Caffeine-containing compound overuse is more common among women; these are over-the-counter (OTC) and often do not appear on patients’ medications lists. Pain specialists should specifically ask patients with headache whether they are using OTC caffeine-containing compounds.

Secondary headache attributed to exposure to or overuse of a substance

Cephalalgia ◽  
2020 ◽  
pp. 033310242094223
Author(s):  
Kati Toom ◽  
Mark Braschinsky ◽  
Mark Obermann ◽  
Zara Katsarava
Keyword(s):  
Health Care Professionals ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Headache Disorder ◽  
Tension Type Headache ◽  
Secondary Headache ◽  
Primary Headache Disorder ◽  
Type Headache ◽  
Acute Headache

Background Secondary headaches attributed to exposure to or the overuse of a substance are classified under chapter eight in the International Classification of Headache Disorders 3rd edition. Three distinct sub-chapters consider: 1. Headache attributed to exposure to a substance, 2. Medication overuse headache, and 3. Headache attributed to substance withdrawal. Headache attributed to exposure to a substance refers to a headache with onset immediately or within hours after the exposure, while medication overuse headache is a headache occurring on 15 or more days per month that has developed as a consequence of regular usage of acute headache medication(s) for more than three consecutive months in a patient with a pre-existing primary headache disorder. The withdrawal of caffeine, oestrogen, and opioids is most often associated with the development of headache. Discussion Despite the current headache classification, there is no certainty of a causal relationship between the use of any substance and the development of headache. Some substances are likely to provoke headache in patients that suffer from a primary headache disorder like migraine, tension-type headache or cluster headache, while others were described to cause headache even in people that generally do not get headaches. Toxic agents, such as carbon monoxide (CO) are difficult to investigate systematically, while other substances such as nitric oxide (NO) were specifically used to induce headache experimentally. If a patient with an underlying primary headache disorder develops a headache, in temporal relation to exposure to a substance, which is significantly worse than the usual headache it is considered secondary. This is even more the case if the headache phenotype is different from the usually experienced headache characteristics. Medication overuse headache is a well-described, distinct disease entity with only marginally understood pathophysiology and associated psychological factors. Managing medication overuse headache patients includes education, detoxification, prophylactic treatments and treating comorbidities, which is reflected in available guidelines. Viewing medication overuse headache as a separate entity helps clinicians and researchers better recognise, treat and study the disorder. Conclusion Identification of substances that may cause or trigger secondary headache is important in order to educate patients and health care professionals about potential effects of these substances and prevent unnecessary suffering, as well as deterioration in quality of life. Treatment in case of medication overuse and other chronic headache should be decisive and effective.

Headache

2016 ◽  
Author(s):  
Sathiji Nageshwaran ◽  
Heather C Wilson ◽  
Anthony Dickenson ◽  
David Ledingham
Keyword(s):  
Intracranial Hypertension ◽  
Idiopathic Intracranial Hypertension ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Tension Type Headache ◽  
Secondary Headache ◽  
Trigeminal Autonomic Cephalalgias ◽  
Headache Disorders ◽  
Treatment Regimes ◽  
Type Headache

This chapter on headache discusses the classification, clinical features, treatment regimes, and evidence for treatment of primary (including migraine, tension-type headache, and trigeminal autonomic cephalalgias) and secondary headache (idiopathic intracranial hypertension and medication overuse headache) disorders.

Frequency of diagnoses in a specialized headache clinic in Buenos Aires

2019 ◽  
pp. 66-69
Author(s):  
Vanessa Nagel ◽  
Sol Cavanagh ◽  
Marina Olivier ◽  
Natalia Larripa ◽  
Maria T Gutierrez ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Buenos Aires ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Craniofacial Pain ◽  
Headache Clinic ◽  
Type Headache

Objective: Headache is one of the most frequent reason for consultations in neurology. The global prevalence among adults with migraine is approximately 10% with migraine, 40% for tension-type headache (TTH) and 3% for chronic daily headache. The purpose of this study is to analyze the prevalence of the diagnoses of headache and craniofacial pain among patients evaluated in a specialized headache clinic of Buenos Aires during 2017. Methods: Retrospective, descriptive study. We reviewed the electronic medical records of patients who consulted for headaches or craniofacial pain from January 1st to December 31st, 2017. Diagnoses were made according to the criteria of the International Classification of Headache Disorders (ICHD-3). Results: We reviewed 3254 electronic medical records and documented 3941 diagnoses: headache (93.03%), craniofacial pain (3.62%) and unclassifiable (3.35%). The average age was 43.14 years. 80.7% were women. Primary headaches were the most frequent diagnoses (78.54%). Migraine represented the main diagnosis (87.42%). Episodic migraine without aura was the most prevalent diagnosis (48%). Tension- type headache (TTH) was found in 8.74% of cases of primary headaches and Trigeminal autonomic cephalalgias (TACs) in 2.89%. Medication-overuse headache (MOH) represented 77.93% of the secondary headaches, and most of them also met chronic migraine criteria fulfilled criteria of chronic migraine. Primary trigeminal neuralgia represented 50% of craniofacial pain and 27% were secondary trigeminal neuralgia, mostly postherpetic or posterior to dental procedures. Regardin to the frecuency, 33.58% of the patients had chronic headache. Conclusion: In our section, migraine is the most frequent diagnosis followed by medication-overuse headache. The percentage of chronic headache is higher than the prevalence in the general population, probably because it is a tertiary center.

Medication overuse headache in 787 patients admitted for inpatient treatment over a period of 32 years

Cephalalgia ◽  
2020 ◽  
Vol 40 (8) ◽  
pp. 808-817 ◽  
Author(s):  
Sabine Salhofer-Polanyi ◽  
Karin Zebenholzer ◽  
Thomas Berndl ◽  
Kastriot Kastrati ◽  
Sandra Raab ◽  
...  
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Opioid Analgesics ◽  
Tension Type Headache ◽  
P Value ◽  
Cumulative Number ◽  
Number Of Patients ◽  
Withdrawal Therapy ◽  
Type Headache ◽  
Over Time

Background Definitions of medication overuse headache have changed over time. Objective To evaluate the clinical characteristics of medication overuse headache patients admitted for inpatient withdrawal therapy over a period of 32 years. Methods We included all patients with medication overuse headache treated from 1 January 1984 to 31 December 2015. We obtained all data from the medical reports and defined three periods, P1 (1984–1993), P2 (1994–2003), and P3 (2004–2015). The p-value adjusted for multiple comparisons was set to 0.005. Results Within 32 years, a total of 787 patients accounted for 904 admissions for MOH. From P1 to P3, the proportion of patients with preexisting migraine increased from 44.3% to 53.3% (chi2 = 9.0, p = 0.01) and that with preexisting tension-type headache decreased from 47.9% to 34.6% (chi2 = 9.3, p < 0.01). The median time since onset of headache and medication overuse headache decreased from 20 to 15 years ( p < 0.001) and from 3 to 2 years ( p < 0.001). The median cumulative number of single doses decreased from 120 to 90 per month ( p = 0.002). Overuse of triptans, non-opioid analgesics, and opioids increased, whereas overuse of ergotamines decreased over time ( p < 0.001 for all tests). The use of prophylactic medication before admission increased from 8.3% to 29.9% (chi2 = 89.5, p < 0.001). Conclusion This retrospective study in a large number of patients with medication overuse headache admitted for inpatient withdrawal therapy over a period of 32 years shows a trend towards changes in the preexisting headache type, a decrease in the time since onset of headache and medication overuse headache, a decrease in the number of drug doses used per month, changes in the type of drugs overused, and an increase in, but still low rate, of prophylactic medication prior to admission.

scholarly journals Medication Overuse Headache: A Trap for the Headache Patients

2013 ◽  
Vol 3 (2) ◽  
pp. 94-98
Author(s):  
A Rahman ◽  
R Habib ◽  
NB Bhowmik ◽  
A Haque
Keyword(s):  
Chronic Daily Headache ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Headache Disorder ◽  
Tension Type Headache ◽  
Clinical Impression ◽  
Drug Induced ◽  
Daily Headache ◽  
Drug Induced Headache

Medication Overuse Headache (MOH) was previously termed analgesic rebound headache, drug-induced headache, and medication-misuse headache. It is not a primary headache but frequently coexists with primary chronic daily headache. All acute symptomatic medications used to treat headaches have the potential for causing MOH. Highest with opioids, butalbital-containing combination analgesics, and aspirin/ acetaminophen/caffeine combinations. The development is typically preceded by an episodic headache disorder, usually migraine or tension-type headache, that has been treated with frequent and excessive amounts of acute symptomatic medications. The diagnosis is based upon clinical impression. A history of analgesic use averaging more than two to three days per week in association with chronic daily headache is suggestive. The diagnosis is made when the pattern of frequent headaches fulfills the diagnostic criteria for MOH. The basic steps in the management: Patient education, withdrawal of the offending medication, bridge (transitional) therapy, establishment of a headache treatment regimen covering acute and preventive care, follow up and relapse prevention. Birdem Med J 2013; 3(2): 94-98 DOI: http://dx.doi.org/10.3329/birdem.v3i2.17213

Medication Overuse Headache and Chronic Migraine in a Specialized Headache Centre: Field-Testing Proposed New Appendix Criteria

Cephalalgia ◽  
2009 ◽  
Vol 29 (2) ◽  
pp. 214-220 ◽  
Author(s):  
P Zeeberg ◽  
J Olesen ◽  
R Jensen
Keyword(s):  
Chronic Migraine ◽  
Pain Perception ◽  
Medication Overuse ◽  
International Headache Society ◽  
Medication Overuse Headache ◽  
Field Testing ◽  
Tension Type Headache ◽  
Main Body ◽  
Headache Centre ◽  
Type Headache

The classification subcommittee of the International Headache Society (IHS) has recently suggested revised criteria for medication overuse headache (MOH) and chronic migraine (CM). We field tested these revised criteria by applying them to the headache population at the Danish Headache Centre and compared the results with those using the current criteria. For CM we also tested two alternative criteria, one requiring ≥ 4 migraine days/month and ≥ 15 headache days/month, the second requiring ≥ 15 headache days/month and ≥ 50% migraine days. We included 969 patients with migraine or tension-type headache (TTH) among 1326 patients treated and dismissed in a 2-year period. Two hundred and eighty-five patients (30%) had TTH, 265 (27%) had migraine and 419 (43%) had mixed migraine and TTH. The current criteria for MOH classified 86 patients (9%) as MOH, 98 (10%) as probable MOH and 785 (81%) as not having MOH after a 2-month drug-free period. Using the appendix criteria, 284 patients (29%) were now classified as MOH, no patients as probable MOH and 685 (71%) as not having MOH. For CM only 16 patients (3%) fulfilled the current diagnostic criteria. This increased to 42 patients (7%) when we applied the appendix criteria. Using the less restrictive criteria of ≥ 4 migraine days and ≥ 15 headache days, 88 patients (14%) had CM, whereas the more restrictive criteria of ≥ 15 headache days and ≥ 50% migraine days resulted in 24 patients (4%) with CM. Our data suggest that the IHS has succeeded in choosing new criteria for CM which are neither too strict, nor too loose. For MOH, a shift to the appendix criteria will increase the number of MOH patients, but take into account the possibility of permanent changes in pain perception due to medication overuse and the possibility of a renewed effect of prophylactic drugs due to medication withdrawal. We therefore recommend the implementation of the appendix criteria for both MOH and CM into the main body of the International Classification of Headache Disorders.

Application of ICHD-II Criteria for Headaches in a TMJ and Orofacial Pain Clinic

Cephalalgia ◽  
2009 ◽  
Vol 30 (1) ◽  
pp. 37-41 ◽  
Author(s):  
J-K Kang ◽  
J-W Ryu ◽  
J-H Choi ◽  
RL Merrill ◽  
ST Kim
Keyword(s):  
Muscle Pain ◽  
Orofacial Pain ◽  
Temporomandibular Disorder ◽  
Age Groups ◽  
Primary Headache ◽  
Headache Disorder ◽  
Tension Type Headache ◽  
Pain Clinic ◽  
Temporal Muscle ◽  
Type Headache

The aim of this study was to identify and diagnose headache in a temporomandibular joint and orofacial pain clinic population using the second edition of The International Classification of Headache Disorder criteria. In 502 temporomandibular disorder and orofacial pain patients, 246 patients (49%) were diagnosed with tension-type headache (TTH), followed by migraine without aura (14.5%), probable migraine (12.9%), migraine with aura (7%), probable TTH (4.8%) and cluster headache (0.2%). The prevalence of headaches was compared between male and female patients, and the prevalence of migraine was found to be higher in women than in men. In evaluating by age, the prevalence of migraine was highest in patients in their 20s and 30s and declined as age increased above 40. TTH showed the highest rate throughout all age groups, but it also decreased as age increased. In this study, the prevalence of migraine was lower than that reported in Dr Kim et al.'s study, and the prevalence of TTH much higher than that reported in the previous study. Of the headache patients, 81.1% presented with masseter muscle pain and 47.8% with temporal muscle pain. This finding suggests that pericranial muscle pain may be an inducing factor of primary headache.

scholarly journals Migraine, tension-type headache and medication-overuse headache in a large population of shift working nurses: a cross-sectional study in Norway

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e022403 ◽  
Author(s):  
Bjørn Bjorvatn ◽  
Ståle Pallesen ◽  
Bente E Moen ◽  
Siri Waage ◽  
Espen Saxhaug Kristoffersen
Keyword(s):  
Shift Work ◽  
Chronic Headache ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Tension Type Headache ◽  
Work Schedule ◽  
Shift Work Disorder ◽  
Insomnia Disorder ◽  
Type Headache ◽  
Night Shifts

ObjectivesTo investigate associations between different types of headaches and shift work.Design, participants and outcome measuresNurses with different work schedules (day work, two-shift rotation, night work, three-shift rotation) participated in a cohort study with annual surveys that started in 2008/2009. In 2014 (wave 6), a comprehensive headache instrument was included in the survey, in which 1585 nurses participated. Headaches were assessed according to the International Classification of Headache Disorders IIIb. Frequent headache (≥1 day per month), migraine, tension-type headache, chronic headache (headache >14 days per month) and medication-overuse headache (chronic headache + acute headache medication ≥10 days last month) comprised the dependent variables. Adjusted (for sex, age, percentage of full-time equivalent, marital status, children living at home) logistic regression analyses were conducted with work schedule, number of night shifts worked last year, number of quick returns (<11 hours in-between shifts) last year, shift work disorder and insomnia disorder as predictors.ResultsFrequent headache, migraine and chronic headache were associated with shift work disorder (OR 2.04, 95% CI 1.62 to 2.59; 1.60, 1.21 to 2.12; 2.45, 1.25 to 4.80, respectively) and insomnia disorder (OR 1.79, 95% CI 1.43 to 2.23; 1.55, 1.18 to 2.02; 3.03, 1.54 to 5.95, respectively), but not with work schedule, number of night shifts or number of quick returns. Tension-type headache was only associated with >20 night shifts last year (OR 1.41, 95% CI 1.07 to 1.86). Medication-overuse headache was only associated with insomnia disorder (OR 7.62, 95% CI 2.48 to 23.41).ConclusionsWe did not find any association between different types of headaches and work schedule. However, tension-type headache was associated with high number of night shifts. Nurses with sleep disorders (insomnia disorder and shift work disorder) reported higher prevalence of frequent headaches, migraine, chronic headache and medication-overuse headache (only insomnia) compared with nurses not having insomnia disorder and shift work disorder, respectively.

Efficacy of Multidisciplinary Treatment in a Tertiary Referral Headache Centre

Cephalalgia ◽  
2005 ◽  
Vol 25 (12) ◽  
pp. 1159-1167 ◽  
Author(s):  
P Zeeberg ◽  
J Olesen ◽  
R Jensen
Keyword(s):  
Medication Overuse Headache ◽  
Multidisciplinary Treatment ◽  
Tension Type Headache ◽  
Headache Frequency ◽  
Female Ratio ◽  
Headache Centre ◽  
Male Female Ratio ◽  
Type Headache ◽  
Clinical Records ◽  
Absence From Work

Despite the high prevalence of headaches, multidisciplinary headache clinics are few and their efficacy still needs validation. We set out to describe the procedures, characterize the patients and evaluate the treatment results in Danish Headache Centre. All clinical records for patients discharged in 2002 were systematically reviewed. Diagnoses were classified in accordance with ICHD-II. Outcome results were analysed with respect to headache diagnoses, frequency, intensity, absence from work and medication use. Five hundred and five patients were included and 336 were eligible for the study. Mean age was 46 years and male/female ratio 1 : 2.4. For patients without medication overuse headache (MOH) a reduction in headache frequency (P < 0.01) and intensity ( P < 0.05) was seen for frequent episodic and chronic tension-type headache (TTH), migraine, cluster and other headaches. No reduction was seen in post-traumatic headache. Absence from work decreased significantly for migraine ( P < 0.001) and frequent episodic TTH (P < 0.05). For patients with MOH a reduction in headache frequency was seen for TTH and migraine ( P < 0.001). A specialized headache centre is valuable in treatment of patients with complex headache disorders.

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