Main Clinical Characteristics of Medication Overuse Headache - What Clinicians Should Know

Key Points

Medication Overuse Headache (MOH) is a secondary headache disorder.

The diagnosis of MOH is clinical, and its treatment is individualized and highly dependent on a multidisciplinary team approach.

Assessing the risk factors of MOH occurrence and treatment success is crucial for primary and secondary prevention of this type of headache.

MOH is a treatable and preventable public problem worldwide.

The gain from treating patients with MOH is potentially high and may lead to substantial economic savings for society as well as for individual patients.

The Multifaceted Approach to Medication Overuse Headache

The treatment of Medication Overuse Headache (MOH) requires a comprehensive and multidisciplinary approach. Successful management involves not only discontinuing the overuse of medications, but also implementing transitional therapy, preventive strategies, and ongoing monitoring to prevent relapse. Patient education and awareness are equally crucial, as empowering individuals with MOH to understand the condition and its management is key to achieving long-term success. By adopting this holistic approach, healthcare professionals can effectively address the complex nature of MOH, leading to significant improvements in patient outcomes and substantial economic benefits for both the individual and society as a whole [1,2].

Importance of Assessing Risk Factors and Treatment Success

The assessment of risk factors for the occurrence of Medication Overuse Headache (MOH) and the evaluation of treatment success are crucial for the primary and secondary prevention of this type of debilitating headache. The diagnosis of MOH is primarily clinical in nature, and the treatment approach must be highly individualized, relying on a multidisciplinary team of experts, including neurologists, pain management specialists, and behavioral psychologists [3,4]. This comprehensive, collaborative approach should ideally be initiated in primary care settings, with more complex cases referred to neurologists who specialize in managing this condition. For patients suffering from MOH who lack adequate information about available treatment options, a tailored detoxification and prevention program should be selected based on their clinical presentation and the proven efficacy of the interventions. Careful management of medication overuse, whether it involves common painkillers, ergot medications, triptans, opioids, barbiturates, or tranquilizers, is essential, with abrupt discontinuation or gradual tapering depending on the type of medication. Furthermore, the specific type of MOH is a critical factor in determining the most appropriate location and method for discontinuing excessive medication use, as treatment can be provided in outpatient, day-clinic, or inpatient settings with similar effectiveness.

Comprehensive Treatment Approach for Medication Overuse Headache (MOH)

Addressing the multifaceted nature of MOH requires a comprehensive treatment approach that combines various strategies. Discontinuation of excessive medication use is a crucial first step, whether it involves abruptly stopping the overuse of common painkillers, ergot medications, and triptans, or gradually discontinuing opioids, barbiturates, and tranquilizers. Transitional therapy can then be implemented to help patients manage withdrawal symptoms and prevent relapse. Equally important is the implementation of preventive therapy, which aims to address the underlying causes of MOH and develop long-term strategies to mitigate the risk of recurrence. Relapse monitoring and patient education are also essential components of the therapeutic approach, empowering individuals with MOH to understand the condition, adhere to their treatment plan, and recognize the signs of potential relapse. By addressing these key elements in a multidisciplinary manner, healthcare providers can effectively manage MOH and help patients achieve sustainable relief from this debilitating condition.

The Substantial Benefits of Treating Medication Overuse Headache (MOH)

Despite the challenges involved, MOH is a highly treatable and preventable public health issue worldwide. The gains from effectively treating patients suffering from this condition can be substantial, leading to significant economic savings for both society and individual patients. By implementing comprehensive treatment approaches that address the underlying causes of medication overuse, healthcare providers can help patients achieve lasting relief from their debilitating headaches. This not only improves the quality of life for those affected, but also reduces the substantial societal costs associated with chronic headache disorders. Given the significant burden that MOH places on both individuals and the healthcare system, the potential benefits of effective treatment are tremendous and warrant further investment and research in this critical area [5-10].

Acknowledgments

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Conflict of Interest

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References

• Headache Classification Committee of the International Headache Society (2018) Headache Classification Committee of the International Headache Society (IHS) the international classification of headache disorders, 3^rd Cephalalgia 38(1): 201-211.
• Westergaard ML, Hansen EH, Glümer C, Jes Olesen, Rigmor H Jensen, et al. (2014) Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates: a systematic review. Cephalalgia 34(6): 409-425.
• Rapoport AM (2008) Medication overuse headache: awareness, detection and treatment. CNS Drugs 22(12): 995-1004.
• Evers S, Jensen R (2011) Treatment of medication overuse headache Guideline of the EFNS headache panel. Eur J Neurol 18(9): 1115-1121.
• Headache Classification Subcommittee of the International Headache Society (2004) The international classification of headache disorders: 2^nd Cephalalgia 24(Suppl 1): 9-160.
• Okada-Ogawa A, Porreca F, Meng ID (2009) Sustained morphine-induced sensitization and loss of Diffuse Noxious Inhibitory Controls (DNIC) in dura-sensitive medullary dorsal horn neurons. J Neurosci 29(50): 15828-15835.
• Srikiatkhachorn A, Tarasub N, Govitrapong P (2000) Effect of chronic analgesic exposure on the central serotonin system: a possible mechanism of analgesic abuse headache. Headache 40(5): 343-350.
• Tohyama Y, Yamane F, Merid MF, Diksic M (2001) Effects of selective 5-HT1A receptor antagonists on regional serotonin synthesis in the rat brain: autoradiographic study with alpha-[14C] methyl-L-tryptophan. Eur Neuropsychopharmacol 11(3): 193-202.
• Dobson CF, Tohyama Y, Diksic M, Hamel E (2004) Effects of acute or chronic administration of anti-migraine drugs sumatriptan and zolmitriptan on serotonin synthesis in the rat brain. Cephalalgia 24(1): 2-11.
• de Goffau MJ, Klaver ARE, Willemsen MG, Patrick J E Bindels, Arianne P Verhagen, et al. (2016) The effectiveness of treatments for patients with medication overuse headache; a systematic review and meta-analysis. J Pain 18(6): 615-627.