Medication overuse headache
Medication overuse headache is a secondary headache disorder in which frequent use of acute headache medications transforms an underlying migraine or tension-type headache into near-daily pain. Management is discontinuing the overused agent and starting migraine-preventive therapy, with acute medication limited to 10 or fewer days per month.
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What this article covers
- Overview
Definition: medication overuse headache, previously called rebound headache, is a secondary headache disorder in which regular overuse of acute headache medication transforms an underlying primary…
- Epidemiology
Prevalence: affects roughly 1% of adults, making it one of the more common chronic headache presentations seen in headache and primary care clinics.
- Risk factors
High baseline headache frequency: patients with frequent primary headaches are more likely to reach for acute medication often enough to cross the overuse threshold.
- Pathophysiology
Central sensitization from repeated exposure: frequent exposure to abortive agents drives changes in central pain-modulating pathways, lowering the threshold for headache and promoting persistent, near-daily pain.
- Clinical features
Daily or near-daily headache: the hallmark presentation is headache occurring most days of the month, often refractory to the very medications the patient has been taking.
- Differential diagnosis
Chronic migraine without medication overuse: shares the 15-or-more headache-days pattern but lacks a qualifying pattern of acute medication overuse on history and headache diary review.
- Diagnosis
First, establish the diagnosis clinically with a headache and medication-use history: a detailed diary of headache frequency, features, and the type and frequency of acute medication use over the…
- Management
First, educate the patient and discontinue the overused acute medication: explain the overuse-headache cycle and set a clear plan to stop the offending drug, since continued use prevents both…
- Complications
Transition to intractable chronic daily headache: without successful discontinuation and prevention, the pattern can become resistant to future treatment attempts.
- Prognosis
Good response to discontinuation: most patients improve substantially within weeks to a few months after successfully stopping the overused medication and starting preventive therapy.
- Prevention
Limit acute medication frequency from the outset: counsel all patients starting an acute headache medication to keep triptan, ergotamine, opioid, or combination-analgesic use to 10 or fewer days per…
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