What is Headache From Medication Overuse?
Medication overuse headache (MOH) is believed to occur when drugs used for headache relief are taken too often. This excessive use can cause another type of headache. In the past, it was known as a rebound headache. If a person with migraines uses pain relief medication excessively, it can turn occasional suffering into a constant condition. The exact amount of time one can take the painkiller before getting medication overuse headache can change, depending on the specific drug. The usual culprits include simple and combination painkillers, such as NSAIDs, triptans, ergot derivatives, and opioids. However, any painkiller could potentially trigger it. MOH is common in people who are likely to overuse quick-fix medications. People already diagnosed with primary headache disorder are at risk for this condition, including those who suffer from migraines and tension-type headaches.
The most recent criteria state that medication overuse headache is defined as a headache that happens 15 or more days each month, resulting from overusing quick-fix headache medications for over three months. It is typically resolved once the problematic medication is reduced.
What Causes Headache From Medication Overuse?
To be diagnosed with ‘medication overuse headache’ according to the latest ICHD-3b criteria, three conditions need to be satisfied:
1. The patient, who already has a known headache disorder, experiences headaches for 15 or more days in a month.
2. The patient has been overusing headache-relief medication for more than three months.
3. The headache can’t be explained by any other headache condition listed in ICHD-3.
It’s believed that ‘medication overuse headaches’ can happen when patients take headache-medication too often. For instance, using simple painkillers like acetaminophen or NSAIDs for 15 or more days in a month or using ergotamine, triptans, opioids, or a combination of different painkillers (like butalbital/acetaminophen/caffeine) for ten or more days in a month.
The ICHD-3b guidelines suggest that overuse headaches can be caused by using a combination of different headache medications too frequently, even if none of the individual medications are overused on their own.
It’s important to note that people with headaches react differently to different medications. Using a less effective medicine to stop a headache can actually lead to needing more of the medication, and potentially triggering a ‘medication overuse headache.’ For example, a patient using acetaminophen may end up needing to take it more often to control their headache compared to someone using ibuprofen, as ibuprofen is usually more effective in treating migraines.
Risk Factors and Frequency for Headache From Medication Overuse
Medication overuse headache is one of the most common neurological disorders, affecting approximately 1% of people globally. This means that around 58.5 million people suffer from it worldwide. Despite its prevalence, it is less common than migraines and tension-type headaches. However, it’s still considered one of the top 20 most debilitating diseases according to a 2015 study.
It’s particularly common amongst people with chronic migraines, with about 32% of these individuals experiencing medication overuse headaches. Although it can affect anyone, it’s more typical in women, and those with a lower socioeconomic status.
- Medication overuse headache is a common neurological disorder.
- It affects around 1% of people globally, approximately 58.5 million individuals.
- It’s less common than migraines and tension-type headaches, but still ranked among the top 20 most debilitating diseases.
- Approximately 32% of individuals with chronic migraines also suffer from medication overuse headaches.
- It’s particularly prevalent amongst women and individuals with lower socioeconomic status.
Signs and Symptoms of Headache From Medication Overuse
Medication overuse headache is a condition where the symptoms can fluctuate for each patient and even change over time for the same person. This may result in an increase in the usual frequency of headaches or a new type of headache appearing. As there are no specific tests to diagnose this, we rely on details such as how often the headaches are happening and the type and frequency of acute medication being used. Although the location and quality of pain in medication overuse headache can’t be specified, there are some common traits observed in these patients.
- The headaches usually come and go
- The amount of acute medication taken often varies, depending on the specific abortive medication used
- Neck pain is common and can be mistaken for a headache that originates from the neck, which usually doesn’t respond to neck pain treatments
- The headache commonly occurs in the morning, likely due to withdrawal during sleep
- Poor sleep
- Symptoms such as nasal congestion, runny nose, and stomach upset occur more frequently with the overuse of opioids
- Anxiety and depression often occur alongside this condition
- All treatments for headaches usually work less effectively when medication overuse headache is present; the efficiency improves after stopping the overuse of medication.
Testing for Headache From Medication Overuse
At the moment, there aren’t any specific tests or markers that can accurately detect medication overuse headaches. The condition is identified purely through clinical evaluation. Thus, it’s incredibly important for medical professionals to pay special attention to this condition, as it can get worse over time if not identified and treated promptly.
Treatment Options for Headache From Medication Overuse
The usual treatment for medication overuse headaches involves helping the patient gradually stop using the headache medication that’s causing the problem, while also starting preventative treatments. These treatments can include both prophylactic medications (drugs that are used to prevent disease) and non-drug treatments like cognitive behavioral therapy, biofeedback, relaxation training, and lifestyle changes such as avoiding triggers that might cause headaches.
Studies have shown that the best results are seen when the patient completely stops taking the overused medication, rather than continuing to take it but with limits on frequency. Patients are allowed to be prescribed a new medication for acute headaches that belongs to a different class from the overused drug. The weaning process can happen abruptly, or gradually over several weeks.
Education for the patient and their family about the importance of limiting acute headache medication is very important in the prevention of medication overuse headaches. In the early days of weaning off the medication, it’s common for a patient’s headache to actually get worse. Symptoms of withdrawal usually last for up to ten days, but should then be followed by improvement in the headache pain.
Treatment can be done on an outpatient basis; most cases are managed this way, through educating patients about cutting back on their acute medication use. It’s crucial to also address and treat related mental health conditions like anxiety and depression, which often show up alongside medication overuse headaches – but without causing the headache to become worse through the anxiolytic effects of the medication.
Even after successful weaning, around half of patients relapse after five years, so it’s crucial to maintain regular follow-up appointments. When the patient’s medication overuse headache has gone away, the doctor may consider tapering them off the preventative medicine. There are no strict guidelines for this, but some healthcare providers suggest stopping the preventative medication after a year.
What else can Headache From Medication Overuse be?
A ‘medication overuse headache’ typically happens to people who already suffer from occasional primary headaches. This means that the diagnosis often includes considering chronic versions of these occasional headaches. In addition to this, other types of secondary headaches should also be considered and ruled out, based on the person’s health history and all the various necessary tests. This becomes even more vital when the characteristics of the original occasional headache differ from the ongoing, chronic headache.
What to expect with Headache From Medication Overuse
A tailored treatment plan generally yields great results in the long run. However, it’s important to note that the estimated recurrence rate is approximately 30% within six months. Moreover, about half of the patients experience a relapse within five years.
Possible Complications When Diagnosed with Headache From Medication Overuse
Medication overuse headaches can sometimes come with other issues. These may include:
- Nausea
- Anxiety
- Irritability
- Asthenia (weakness)
- Restlessness
- Problems concentrating
- Memory difficulties
- Depression
Preventing Headache From Medication Overuse
Patients need to understand the cause of their headaches to effectively follow changes in their medication plan. Most of the time, they will need to limit their medication use. Depending on the specific medication, patients may need to either stop their medication at once or slowly decrease the dose.
