Medication Overuse Headaches

Medication overuse headaches (MOH) are a type of headache disorder that occurs when an individual takes too many pain-relieving medications, leading to an increase in frequency and severity of headaches.

Causes and Risk Factors

MOH is often caused by the frequent or excessive use of over-the-counter (OTC) or prescription pain medications, such as:

• Triptans
• Ergots
• Opoids
• Combination analgesics (e.g., acetaminophen and codeine)
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen

Individuals who are at risk of developing MOH include those who:

• Have a history of frequent headaches
• Take pain medications regularly for an extended period
• Have a family history of headache disorders
• Experience stress, anxiety, or depression

Symptoms

The symptoms of MOH may vary from person to person but often include:

• Frequent headaches (more than 15 days per month)
• Headaches that worsen over time
• Headaches that are more severe or longer-lasting than usual
• Sensitivity to light, sound, or smells
• Nausea and vomiting

Diagnosis

MOH is typically diagnosed based on a combination of:

• Medical history
• Physical examination
• Headache diary or calendar to track headache frequency and severity
• Imaging studies (e.g., MRI or CT scan) to rule out other underlying conditions

Treatment and Management

Treatment for MOH typically involves:

• Withdrawal from the overused medication(s)
• Pain management with alternative medications, such as:
• Corticosteroids to reduce inflammation
• Anti-nausea medications
• Preventive medications (e.g., topiramate or propranolol) to reduce headache frequency
• Lifestyle modifications, such as:
• Stress management techniques (e.g., meditation or yoga)
• Regular exercise and physical activity
• Adequate sleep and relaxation

Prevention

To prevent MOH, individuals can take the following steps:

• Use pain medications only as directed by a healthcare provider
• Keep a headache diary to track medication use and headache frequency
• Avoid overusing or combining multiple pain medications
• Seek medical attention if headaches worsen or become more frequent