Medication Overuse Headache: When Meds Cause the Pain

How do we stop MOH?
Immediately discontinuing the medication causing the MOH is the preferred plan of action. It's obviously the quickest, and it doesn't add more medications to an already confused body. According to Goadsby, et al, withdrawal symptoms usually last two to 10 days. Those symptoms may include: withdrawal headache, vomiting, arterial hypotension, tachycardia, sleep disturbances, restlessness, anxiety, nervousness. In some cases where the MOH is being caused by medications such as butalbital compounds that have been taken daily in large amounts, seizures can occur if the medication is abruptly withdrawn, so a tapered withdrawal or supervised detoxifications is necessary. The best approach is to ask your doctor for help and advice.

Will taking pain medications for pain other than head pain cause MOH?
I posed these two questions to Dr. Stewart Tepper of the New England Center for Headache: Does a Migraineur need to be careful about developing MOH from meds taken for pain other than head pain? Is this situation different for Migraineurs and non? His reply was:

Which comes first, chicken or egg? Increased medication use or increased headaches? To answer this question and so assist in establishing causality, we may require reports of patients with episodic migraine who use analgesics or anti-inflammatories for a purpose other than headache and who then developed CDH. Bahra et al reported on 105 patients in a rheumatology clinic who took regular and mixed analgesics and anti-inflammatories for arthritic pain and not for headache. Chronic daily headache was present in 8 (7.6%) of these patients, and all had a history of previous episodic migraine. Regular analgesic use preceded or coincided with onset of CDH in 7 of these 8 patients. No patient lacking a previous history of migraine developed CDH.
    Wilkinson et al studied 28 patients who underwent total colectomy for ulcerative colitis; patients with a previous history of CDH were excluded. Eight of the 28 patients used opioids at least 5 days per week. All patients with a previous history of migraine who overused opiates developed CDH, whereas no patient lacking a history of prior migraine who overused opiates did so...
     These two small studies suggest that overuse of analgesics, in the absence of increased frequency of headache and for purposes other than the treatment of headache, can result in the precipitation of CDH.
     Further, Isler, in 1982,  studied 235 patients with CDH between1978-1981. He stated: “Withdrawal of attack drugs alone [i.e. without other rx] led to a marked reduction of frequency of headache, indicating that excessive intake of these drugs is much more a cause than a consequence of frequent and chronic migraine..."

If you take away just one sentence from his reply, let it be this one, "The authors concluded that frequent opiate use could produce CDH in susceptible individuals, and that patients with previous headache had a particular susceptibility to this outcome."

Summary:
Unfortunately, it seems that any medication we take for headache or Migraine relief has the potential to cause MOH if used more than two or three days a week. In the long run, a good preventive regimen that will reduce our need for MOH-causing medications is our best weapon against MOH. Until we perfect our preventive regimens to that point, it's essential to work with our doctors to prevent MOH.

>>For a more detailed version of this article, click HERE.<<

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References:

The International Headache Society. "The International Classification of Headache Disorders, 2nd Edition." (ICHD-II) September, 2004. www.i-h-s.org.

Goadsby, Peter J., MD, PhD, DSc, FRACP, FRCP; Silberstein, Stephen D., MD, FACP; Dodick, David W., MD, FRCPD, FACP. Chronic Daily Headache for Clinicians. Hamilton, Ontario: BC Decker. 2005.

Sheftell, Fred D. & Bigal, Marcelo (2004) "Clinical Science: Headache Induced by Acute Medication Overuse." Headache Currents 1 (3), 64-68. doi: 10.1111/j.1743-5013.2004.10109.x.

Young, William B. (2004) "Clinical Science: Treatment of Medication Overuse Headache and Long-term Outcome." Headache Currents 1 (3), 55-59. doi: 10.1111/j.1743-5013.2004.10112.x.

Tepper SJ and Dodick DW. "Debate: Analgesic Overuse is a Cause, Not Consequence, of Chronic Daily Headache." Headache 2002;42:543-554.