Makindo Medical Notes

Related Subjects:Migraine |Basilar Migraine |Cluster Headaches |Sumatriptan |Tension Headache |Analgesic Overuse Headache |Headaches in General

About

Medication Overuse Headache (MOH) is a chronic headache disorder triggered by the frequent or excessive use of analgesics or other headache medications. It commonly affects patients with pre-existing migraine or tension-type headaches who overuse medications in an attempt to manage their symptoms.

• Primary Cause: Frequent or excessive use of analgesics or headache-specific medications.
• Commonly Affected Patients: Those with migraine or other chronic headache disorders who overuse medications.

Clinical Presentation

MOH typically presents with the following clinical features:

• Persistent, low-grade headache that may be present upon waking and persist throughout the day.
• Headache is often partially relieved with analgesics but returns shortly after, leading to a cycle of overuse.
• Headache is present on most days, often experienced as a dull, constant pain.

Suspect Medication Overuse Headache If:

• The patient experiences headaches on at least 15 days per month and has a pre-existing headache disorder (e.g., migraine).
• The patient has been overusing headache medications for more than 3 months. This includes drugs used for acute or symptomatic headache treatment, such as:
  • Ergotamines
  • Triptans
  • Simple analgesics (e.g., acetaminophen, ibuprofen)
  • Opioids

Investigations

In MOH, structural imaging studies (e.g., MRI or CT scan) typically show no abnormalities, helping to exclude other potential causes of chronic headaches.

• Imaging: Normal in most cases, primarily used to rule out other conditions.

Differential Diagnosis

Other conditions to consider when diagnosing MOH include:

• Migraine: Particularly if the patient has a history of episodic migraines that have become more frequent.
• Brain Tumor: Chronic headaches with neurological symptoms or abnormal imaging findings should prompt consideration of an intracranial mass.
• Benign Intracranial Hypertension (BIH): Often presents with daily headaches and may be accompanied by visual symptoms or papilledema.

Management

Effective management of MOH requires both medication adjustment and patient support to reduce reliance on analgesics.

• Gradual Reduction of Analgesic Use: Reducing the frequency of analgesic intake is essential to break the cycle of dependency and chronic headache.
• Prophylactic Therapy for Background Headache: For patients with an underlying migraine disorder, initiating prophylactic treatment (e.g., beta-blockers or antiepileptics) can help reduce headache frequency.
• Tricyclic Antidepressants (TCAs): Medications such as amitriptyline may be beneficial in managing chronic headache associated with MOH.
• Patient Education and Support: Long-term prognosis depends on the patient’s ability to reduce analgesic usage, which often requires consistent follow-up and support from healthcare providers.