Medicine- overuse-
headache
Medication overuse headache (MOH) is a type of headache that occurs as a result of prolonged and excessive use of medication to treat headaches.
The effect is the opposite of the desired one, where the medicine intended to relieve the headache instead causes it.
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MOH is a headache that occurs due to long-term use of headache medication.
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Remember that the limit on the combination of, for example, paracetamol and caffeine pills, or paracetamol and ibuprofen, is only 9 days.
If you use the combination 10 days per month over 3 months, you are at risk of developing MOH.
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Treatment may include discontinuation of overused medications, introduction of preventive treatments, and lifestyle changes to prevent relapse.
ICHD-3 defines MOH based on type of medicine and frequency of use:
- Certain painkillers (such as paracetamol or ibuprofen and other NSAIDs): Overuse is defined as using these medications 15 or more days per month for more than three months.
- Stronger medications (such as opioids, triptans, or ergotamines): Overuse is defined as using these medications 10 or more days per month for more than three months.
- Combination medications: Overuse is defined as using a combination of medications 10 or more days per month for more than three months.
How common is medication overuse headache?
Among the adult population, approximately 1-2%, or 30-40,000 people in Norway, suffer from MOH. The condition occurs more often in women than in men.
Typical symptoms:
The symptoms of MOH can vary significantly from person to person, but often include chronic headaches, nausea, as well as hypersensitivity to light (photophobia) and sound (phonophobia).
What mechanisms lead to medication overuse headaches?
MOH occurs as a result of neurological and vascular mechanisms involving nerves and blood vessels. Repeated use of painkillers can alter the pain response in the brain, leading to increased sensitivity and more frequent headache attacks.
Seizures associated with medication overuse headache
MOH attacks can last all day, but if related to migraine, they can last from 4 to 72 hours. Many people with MOH experience waking up with a headache. MOH can also be constant.
How do you get diagnosed
How are you diagnosed:
The diagnosis of MOH is made based on the patient's clinical history, including the pattern of headache frequency and medication use, according to the ICHD-3 criteria.
A headache diary is essential for logging the frequency and duration of headaches, as well as medication use.
Preventive measures
Preventive measures include education about the risks of medication overuse, use of preventive medication to reduce headache frequency, and implementation of non-pharmacological therapies such as CBT. Regular follow-up and monitoring is essential.
Recommended treatment
The treatment of MOH involves discontinuation of the overused medications, management of withdrawal symptoms, and introduction of preventive treatments to reduce headache frequency.
Behavioral therapies and patient education on proper medication use are also important components of treatment.
Some patients may require sick leave during the treatment phase to manage withdrawal and increased headache frequency.
Treatment can often be carried out through the GP, but hospitalization during discontinuation may be necessary for long-term overuse of stronger painkillers.
Some will need preventative medication such as CGRP, which can only be prescribed by a neurologist.
ICHD-3 diagnostic criteria:
MOH is diagnosed as headache occurring on ≥15 days per month for at least 3 months, in a person overusing acute headache medication according to the following criteria:
- Certain painkillers (paracetamol, NSAIDs): Use 15 or more days per month.
- Stronger medications (opioids, triptans, ergotamines): Use 10 or more days per month.
- Combination medicines: Use 10 or more days per month.
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