Category: Neurology
Keywords: headache, post concussion syndrome (PubMed Search)
Posted: 12/16/2018 by Brian Corwell, MD
(Updated: 12/23/2018)
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A previous pearl discussed medication-overuse headache (MOH).
MOH is also known as analgesic rebound headache, drug-induced headache or medication-misuse headache.
It is defined as headache… occurring on 15** or more days per month in a patient with a preexisting headache disorder who has been overusing one or more acute treatment drugs for headache with symptoms for three or more months.
The diagnosis is clinical, and requires a hx of chronic daily headache with analgesic use more than 2-3d per week.
The diagnosis of MOH is supported if headache frequency increases in response to increasing medication use, and/or improves when the overused medication is withdrawn.
The headache may improve transiently with analgesics and returns as the medication wears off. The clinical improvement after wash out is not rapid however, patients may undergo a period where their headaches will get worse. This period could last in the order of a few months in some cases.
The meds can be dc’d cold turkey or tapered depending on clinical scenario.
Greatest in middle aged persons. The prevalence rages from 1% to 2% with a 3:1 female to male ratio.
Migraine is the most common associated primary headache disorder.
** Each medication class has a specific threshold.
Triptans, ergot alkaloids, combination analgesics, or opioids on ten or more days per month constitute medication overuse.
Use of simple analgesics, including aspirin, acetaminophen and NSAIDS on 15 or more days per month constitutes medication overuse.
Caffeine intake of more than 200mg per day increases the risk of MOH.
Consider MOH in patients in the appropriate clinical scenario as sometimes doing less is more!
