scholarly journals Comprehensive approach for the treatment of medication-overuse headache

2021 ◽  
Vol 64 (12) ◽  
pp. 843-851
Author(s):  
Hong-Kyun Park ◽  
Soo-Jin Cho
Keyword(s):  
Medication Overuse ◽  
Medical Condition ◽  
Botulinum Toxin A ◽  
Medication Overuse Headache ◽  
Healthcare Providers ◽  
Primary Headache ◽  
Headache Disorder ◽  
Primary Headache Disorder ◽  
Education Of Patients ◽  
Frequent Use

Background: Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder that occurs on 15 or more days per month for more than 3 months. It is caused by overuse of medication for acute or symptomatic headache treatment. Regular and frequent use of acute or symptomatic medications can worsen headaches and lead to chronic headache or MOH. MOH is a burdensome medical condition that is difficult to treat, and the frequent recurrence of headaches may result in disability in individuals and impair socioeconomic outcomes.Current Concepts: Awareness of MOH and the education of patients, the general population, and healthcare providers are important for the first step of treatment. Scientific research regarding the treatment of MOH has been published in the past few years.Discussion and Conclusion: Physicians should educate and counsel patients to stop or at least reduce the intake of acute or symptomatic medications that can be discontinued abruptly or tapered slowly. During the period after the discontinuation of the overused medications, some withdrawal symptoms including headache might be manageable with bridging therapy. Evidence-based preventive therapies including anticonvulsants (topiramate and divalproex sodium), botulinum toxin A, and medications acting by antagonism of the calcitonin generelated peptide pathway might be helpful in patients with MOH for both avoiding the overused medication and preventing the relapse of overuse. A comprehensive and multidisciplinary approach may improve the outcomes of patients with MOH.

Case series of sixteen patients with nummular headache

Cephalalgia ◽  
2010 ◽  
Vol 30 (12) ◽  
pp. 1527-1530 ◽  
Author(s):  
Justin Moon ◽  
Kamran Ahmed ◽  
Ivan Garza
Keyword(s):  
Medication Overuse ◽  
Age Of Onset ◽  
Medication Overuse Headache ◽  
Case Series ◽  
Primary Headache ◽  
Headache Disorder ◽  
Therapeutic Interventions ◽  
Nummular Headache ◽  
Primary Headache Disorder ◽  
History Of

Introduction: Nummular headache is a rare primary headache disorder described by a focal circumscribed area of pain (2–6 cm in diameter). Literature on this disorder is sparse. Patients and methods: Here, we describe a case series of 16 patients (6 men, 10 women) seen at the Mayo Clinic. Results: Mean age of onset was 50 years (range, 19–79 years) and mean duration of headache was 7.9 years (range, 0.33–40 years). Location of headache varied and was found to be an average of 3.9 cm in diameter (range, 2–10 cm). Headache was episodic (<15 days/month) in four patients and chronic (>15 days/month) in 12 patients. Attention was paid to therapeutic interventions. Resolution was seen in 38% of patients. Migraine was present in the history of 56% of patients and medication overuse headache was found in 25%. Conclusions: Our series results support previous findings. In our population, no specific therapy was identified to be effective in more than one patient.

Medication Overuse Headache: Clinical Features Predicting Treatment Outcome at 1-Year Follow-Up

Cephalalgia ◽  
2007 ◽  
Vol 27 (11) ◽  
pp. 1219-1225 ◽  
Author(s):  
J Zidverc-Trajkovic ◽  
T Pekmezovic ◽  
Z Jovanovic ◽  
A Pavlovic ◽  
M Mijajlovic ◽  
...  
Keyword(s):  
Chronic Headache ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Age At Onset ◽  
Primary Headache ◽  
Headache Disorder ◽  
Primary Headache Disorder ◽  
A Prospective Study ◽  
Predicting Treatment Outcome

We present a prospective study of 240 patients with medication overuse headache (MOH) treated with drug withdrawal and prophylactic medications. At 1-year follow-up, 137 (57.1%) patients were without chronic headache and without medication overuse, eight (3.3%) patients did not improve after withdrawal and 95 (39.6%) relapsed developing recurrent overuse. Age at time of MOH diagnosis, regular use of benzodiazepines, frequency and Migraine Disability Assessment (MIDAS) score of chronic headache, age at onset of primary headache, frequency and MIDAS score of primary headache, ergotamine compound overuse and daily drug intake were significantly different between successfully and unsuccessfully treated patients. Multivariate analysis determined the frequency of primary headache disorder, ergotamine overuse and disability of chronic headache estimated by MIDAS as independent predictors of treatment efficacy at 1-year follow-up.

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.

scholarly journals Pathophysiology of medication overuse headache: Insights and hypotheses from preclinical studies

Cephalalgia ◽  
2011 ◽  
Vol 31 (7) ◽  
pp. 851-860 ◽  
Author(s):  
Ian D Meng ◽  
David Dodick ◽  
Michael H Ossipov ◽  
Frank Porreca
Keyword(s):  
Migraine Headache ◽  
Potential Role ◽  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Ergot Alkaloids ◽  
Opioid Analgesics ◽  
Primary Headache ◽  
Frequent Use ◽  
Underlying Mechanisms ◽  
Pain Inhibition

Introduction: Medication overuse headache (MOH) is a clinical concern in the management of migraine headache. MOH arises from the frequent use of medications used for the treatment of a primary headache. Medications that can cause MOH include opioid analgesics as well as formulations designed for the treatment of migraine, such as triptans, ergot alkaloids, or drug combinations that include caffeine and barbiturates. Literature review: Gathering evidence indicates that migraine patients are more susceptible to development of MOH, and that prolonged use of these medications increases the prognosis for development of chronic migraine, leading to the suggestion that similar underlying mechanisms may drive both migraine headache and MOH. In this review, we examine the link between several mechanisms that have been linked to migraine headache and a potential role in MOH. For example, cortical spreading depression (CSD), associated with migraine development, is increased in frequency with prolonged use of topiramate or paracetamol. Conclusions: Increased CGRP levels in the blood have been linked to migraine and elevated CGRP can be casued by prolonged sumatriptan exposure. Possible mechanisms that may be common to both migraine and MOH include increased endogenous facilitation of pain and/or diminished diminished endogenous pain inhibition. Neuroanatomical pathways mediating these effects are examined.

Prevalence of Primary Headache Disorders in Kuwait

2017 ◽  
Vol 48 (3-4) ◽  
pp. 138-146 ◽  
Author(s):  
Jasem Yousef Al-Hashel ◽  
Samar Farouk Ahmed ◽  
Raed Alroughani
Keyword(s):  
Medication Overuse Headache ◽  
Primary Headache ◽  
Headache Disorder ◽  
Episodic Migraine ◽  
Tension Type Headache ◽  
Primary Headaches ◽  
Primary Headache Disorder ◽  
Work Related ◽  
Primary Headache Disorders ◽  
Kuwaiti Population

Background: Only an insignificant quantum of data exists on the prevalence of primary headaches among those living in Kuwait. We aimed to determine the prevalence of primary headaches among the Kuwaiti population. Methods: This community-based study included Kuwaiti population aged 18-65 years. Using systematic random sampling, data was collected by the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation questionnaire. Responses to the diagnostic questions were transformed into diagnoses algorithmically to confirm the diagnosis of primary headache. Results: A total of 15,523 patients were identified of whom 9,527 (61%) were diagnosed with primary headache disorder; a female predominance of 62.2% was observed. The mean age was 34.84 ± 10.19. Tension-type headache (TTH) was the most prevalent at 29% followed by episodic migraine (23.11%), chronic migraine (5.4%), and medication overuse headache (2.4%). Primary headache prevalence declined steadily from 71% in those aged 18-30 years to 23% in those over 50 (p < 0. 037). The female:male ratio was 1.7:1. Frequency and severity of primary headache were correlated significantly with lost work days (r = 0.611, p < 0.001 and r = 0.102, p = 0.001, respectively). Conclusions. In Kuwait, primary headache disorder is more frequent in young adults and females. TTH followed by episodic migraine were the more prevalent types of headache. Higher frequency and severe headaches were associated with increasing social and work-related burden.

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

Hemicrania Continua: Who Responds to Indomethacin?

Cephalalgia ◽  
2009 ◽  
Vol 29 (3) ◽  
pp. 300-307 ◽  
Author(s):  
MJ Marmura ◽  
SD Silberstein ◽  
M Gupta
Keyword(s):  
Medication Overuse ◽  
Primary Headache ◽  
Headache Disorder ◽  
Rapid Onset ◽  
Hemicrania Continua ◽  
Paroxysmal Hemicrania ◽  
Autonomic Symptoms ◽  
Primary Headache Disorder ◽  
Unilateral Headache ◽  
Headache Onset

Hemicrania continua (HC) is a primary headache disorder characterized by a continuous, moderate to severe, unilateral headache and defined by its absolute responsiveness to indomethacin. However, some patients with the clinical phenotype of HC do not respond to indomethacin. We reviewed the records of 192 patients with the putative diagnosis of HC and divided them into groups based on their headaches' response to indomethacin. They were compared for age, gender, presence or absence of specific autonomic symptoms, medication overuse, rapidity of headache onset, and whether or not the headaches met criteria for migraine when severe. Forty-three patients had an absolute response and 122 patients did not respond to adequate doses of indomethacin. The two groups did not differ significantly in terms of age, sex, presence of rapid-onset headache, or medication overuse. Autonomic symptoms, based on a questionnaire, did not predict response. Eighteen patients could not complete a trial of indomethacin due to adverse events. Nine patients could not be included in the HC group despite improvement with indomethacin: one patient probably had primary cough headache, another paroxysmal hemicrania; three patients improved but it was uncertain if they were absolutely pain free, and four patients dramatically improved but still had a baseline headache. We found no statistically significant differences between patients who did and did not respond to indomethacin. All patients with continuous, unilateral headache should receive an adequate trial of indomethacin. Most patients with unilateral headache suggestive of HC did not respond to indomethacin.

scholarly journals Effectiveness of paranasal air suction on acute migraine using portable air sucker – a randomized, double blind study

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
S. M. R. Bandara ◽  
S. Samita ◽  
A. M. Kiridana ◽  
H. M. M. T. B. Herath
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Sri Lanka ◽  
Primary Headache ◽  
Headache Disorder ◽  
Low Pressure ◽  
Outcome Variable ◽  
Double Blind ◽  
Primary Headache Disorder ◽  
Before And After

Abstract Background Migraine is a primary headache disorder and is the most common disabling primary headache disorder that occurs in children and adolescents. A recent study showed that paranasal air suction can provide relief to migraine headache. However, in order to get the maximum benefit out of it, an easy to use effective air sucker should be available. Aiming to fulfil the above requirement, a randomized, double blind control clinical trial was conducted to investigate the efficacy of a recently developed low–pressure portable air sucker. Methods Eighty-six Sri Lankan school children of age 16–19 years with migraine were enrolled for the study. They were randomly allocated into two groups, and one group was subjected to six intermittent ten-second paranasal air suctions using the portable air sucker for 120 s. The other group was subjected to placebo air suction (no paranasal air suction). The effect of suction using portable air sucker was the primary objective but side of headache, type of headache, and gender were also studied as source variables. The primary response studied was severity of headache. In addition, left and right supraorbital tenderness, photophobia, phonophobia, numbness over the face and scalp, nausea and generalized tiredness/weakness of the body were studied. The measurements on all those variables were made before and after suction, and the statistical analysis was performed based on before and after differences. As a follow–up, patients were monitored for 24-h period. Results There was a significant reduction in the severity of headache pain (OR = 25.98, P < 0.0001), which was the primary outcome variable, and other migraine symptoms studied, tenderness (left) (OR = 289.69, P < 0.0001), tenderness (right) (OR > 267.17, P < 0.0001), photophobia (OR = 2115.6, P < 0.0001), phonophobia (OR > 12.62, P < 0.0001) nausea (OR > 515.59, P < 0.0001) and weakness (OR = 549.06, P < 0.0001) except for numbness (OR = 0.747, P = 0.67) in the treatment group compared to the control group 2 min after the suction. These symptoms did not recur within 24-h period and there were no significant side effects recorded during the 24-h observation period. Conclusion This pilot study showed that low–pressure portable air sucker is effective in paranasal air suction, and suction for 120 s using the sucker can provide an immediate relief which can last for more than 24-h period without any side effects. Trail registration Clinical Trial Government Identification Number – 1548/2016. Ethical Clearance Granted Institute – Medical Research Institute, Colombo, Sri Lanka (No 38/2016). Sri Lanka Clinical Trial Registration No: SLCTR/2017/018. Date of registration = 29/ 06/2017. Approval Granting Organization to use the device in the clinical trial– National Medicines Regulatory Authority Sri Lanka (16 Jan 2018), The device won award at Geneva international inventers exhibition in 2016 and President award in 2018 in Sri Lanka. It is a patented device in Sri Lanka and patent number was SLKP/1/18295. All methods were carried out in accordance with CONSORT 2010 guidelines.

scholarly journals Diagnosis and management of migraine in ten steps

2021 ◽  
Author(s):  
Anna K. Eigenbrodt ◽  
Håkan Ashina ◽  
Sabrina Khan ◽  
Hans-Christoph Diener ◽  
Dimos D. Mitsikostas ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Consensus Statement ◽  
Preventive Treatment ◽  
Primary Headache ◽  
Headache Disorder ◽  
Clinical Decision ◽  
Diagnosis And Management ◽  
Primary Headache Disorder ◽  
Management Of Complications ◽  
European Headache Federation

AbstractMigraine is a disabling primary headache disorder that directly affects more than one billion people worldwide. Despite its widespread prevalence, migraine remains under-diagnosed and under-treated. To support clinical decision-making, we convened a European panel of experts to develop a ten-step approach to the diagnosis and management of migraine. Each step was established by expert consensus and supported by a review of current literature, and the Consensus Statement is endorsed by the European Headache Federation and the European Academy of Neurology. In this Consensus Statement, we introduce typical clinical features, diagnostic criteria and differential diagnoses of migraine. We then emphasize the value of patient centricity and patient education to ensure treatment adherence and satisfaction with care provision. Further, we outline best practices for acute and preventive treatment of migraine in various patient populations, including adults, children and adolescents, pregnant and breastfeeding women, and older people. In addition, we provide recommendations for evaluating treatment response and managing treatment failure. Lastly, we discuss the management of complications and comorbidities as well as the importance of planning long-term follow-up.

Outcome of Medication Overuse Headache after Abrupt in-Patient withdrawal

Cephalalgia ◽  
2006 ◽  
Vol 26 (5) ◽  
pp. 589-596 ◽  
Author(s):  
G Relja ◽  
A Granato ◽  
A Bratina ◽  
RM Antonello ◽  
M Zorzon
Keyword(s):  
Medication Overuse ◽  
Medication Overuse Headache ◽  
Primary Headache ◽  
Drug Intake ◽  
Patient Withdrawal ◽  
Abrupt Discontinuation ◽  
Medication Abuse ◽  
Daily Headache ◽  
Mean Time

One hundred and one patients suffering from chronic daily headache (CDH) and medication overuse were treated, in an in-patient setting, with abrupt discontinuation of the medication overused, intravenous hydrating, and intravenous administration of benzodiazepines and ademetionine. The mean time to CDH resolution was 8.8 days. The in-patient withdrawal protocol used was effective, safe and well tolerated. There was a trend for a shorter time to CDH resolution in patients who overused triptans ( P = 0.062). There was no correlation between time to CDH resolution and either the type of initial primary headache or duration of medication abuse, whereas time to CDH resolution was related to daily drug intake ( P = 0.01). In multiple regression analysis, daily drug intake, age and type of medication overused were independent predictors of time to CDH resolution. At 3-months' follow-up, no patient had relapsed and was again overusing symptomatic medications.

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