Excessive use of medications by a headache-prone patient can give rise to a chronic headache condition known as medication overuse headache. The patient may present with 10 or more headache episodes per month, with each episode lasting from 2 to 10 days, which only relieve upon taking a pain-killer.
Symptoms of medication overuse headache
The signs and symptoms depend on the medication used originally and the type of headache that was being treated.
The pain due to medication overuse headache improves with analgesic but as its effect wears off, the pain returns.
- Dull constant pain
- Irritability and restlessness
- Loss of concentration
- Poor sleep
Causes of medication overuse headache
A patient with an undiagnosed case of a headache condition such as migraine and sinusitis might keep on taking analgesics to get relief from the pain. However, the underlying condition remains unsolved and the headache returns as the effect of analgesic wear off, forcing the patient to take more analgesics and the cycle repeats itself every day. This excessive use of over the counter analgesics creates a persistent daily headache disorder, better known as medication overuse headache.
- This is most commonly caused by over the counter analgesics but can also develop as a result of overuse of prophylactic medications for conditions other than headaches.
- Several migraine medications such as triptans and ergots are linked with medication overuse headache.
- Chronic uptake of Opioids and Triptans increases the CGRP levels that directly cause Inflammation and Headache.
- Chronic use of analgesics causes central sensitization which may be the cause of the development of withdrawal symptoms as the effect of the medicine wears off.
- Monthly drug intake increases corticotropin-releasing hormone (CTRH) levels in CSF which is one known cause of headache.
- The exact cause for this type of headache is still unknown but all the phenomenon’s are linked to dependence on the medication used and the headache as one of the withdrawal symptoms.
Undiagnosed headache conditions such as migraine and tension headache might cause a patient to take analgesics for the pain but the underlying condition remains unsolved.
- Lack of compliance with the medicine for the type of headache originally been treated
- High prevalence of smoking
- Physically less active
- High BMI
- Sleeping disorders
- Patient with a positive family history
- More prevalent in women as compared to men
- Surprisingly the incidence of medication overuse headache decreases with older age.
Management of medication overuse headache
The number of episodes of headache equal to or more than 3 per week or 15 per month and use of analgesic for pain relief is diagnosed as MOH.
- A proper diagnosis of a health condition should be done.
- Prophylactic medication should be started before it becomes a chronic condition.
- Avoid opioid containing medications.
- Avoid taking OTC analgesics more than 10 days per month.
- Limit the use of triptans and combined analgesics.
- Detoxification of culprit medication should be done
- Gradually taper off the culprit medication
- Use alternate medicine for pain relief
For withdrawal symptoms
- Tricyclic antidepressants and anticonvulsants can help.
- Dihydroergotamine DHE is known as the best transitional treatment to manage the withdrawal symptoms as it covers the period of pain between skipping the culprit medication and starting with the prophylactic for MOH.
- According to several studies, botulinum toxin injection is said to decrease the number of headaches experienced per month.
- Steroids such a prednisone can be used to manage the withdrawal symptoms of MOH.
- Cognitive-behavioral therapy can help you cope with the withdrawal symptoms experienced while giving up the medication.
- Acupuncture, vitamin therapy, and dietary supplements can also provide support during the withdrawal period.
- Sleep properly
- Stay hydrated as dehydration Headaches are very likely to develop into MOH
- Lose weight
- Quit smoking
- Adopt a healthy and active lifestyle
- Identify your headache triggers and try as much as possible to avoid them.
When to consult a doctor?
When you start having headaches 2-3 days a week and have to take an analgesic to relieve the pain you should see your doctor.
Which medicines can cause a headaches?
Over-the-counter analgesics are most commonly linked with headaches. Other medicines that can induce a headache are opioids, triptans, ergots, codeine, caffeine, and naproxen.
What is the most effective treatment for medication overuse headache?
A detox for medication overuse headache is the best-known treatment and makes the other treatments more effective.
Who is more at risk to develop a medication overuse headache?
People who have other headache disorders like migraine and tension headache and people with high BMI and low physical activity mostly develop MOH.
How does the same medicine that provides relief from a headache can cause it?
A patient with an undiagnosed case of a headache condition might keep on taking analgesics to get relief from the pain. However, the underlying condition remains unsolved and the headache returns as the effect of analgesic wear off, forcing the patient to take more analgesic and the cycle repeats itself every day.