d) Medication Overuse Headache

Cause

Medication overuse headache may occur when any acute medication is used in 10 or more days per month.


It can occur as a result of frequent use of analgesic medication for other reasons, particularly in patients predisposed to migraine and tension type headache.

 
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Clinical Features

 

The phenotype can be a tension type or migrainous or a combination of these. Analgesic overuse often develops out of an increasing use of acute treatment in episodic headache, leading to the patient developing chronic headache. The efficacy of prophylactic medication is impaired by analgesic overuse.

 

 
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Management

 

Counsel patient to explain the situation.
This is a vital point if the patient is to successfully withdraw.
Try and address comorbidities of depression, anxiety, addictive personality.
Withdrawal strategy can be either abrupt or gradual and may depend on patient choice.
Some patients may feel more comfortable with a short prophylactic bridging treatment but there is no evidence this affects outcome


It is important to explain to the patient that their headaches will worsen in short term ( approximately 2 weeks).


It is also important to explain that their original headache problem will persist; it is the analgesic overuse component of their headache that will improve.


Also emphasise the importance of not restarting these medications

 

Practice Point

Patient with other clinical conditions such as cluster headache do not tend to develop TTH unless they have predisposition to migraine or TTH. When they develop analgesic overuse headache they will develop a supra added migraine or TTH in addition to their cluster headache