Overuse of headache medications can lead to even more pain

Headaches caused by the overuse of pain medications, commonly called "medication overuse headaches," (MOH) is a global problem that deserves serious research and exploration of treatment strategies.

Such is the conclusion reached by a collection of research papers that explores the incidence of MOH in eight nations. Results were published in a supplement to the November issue of Cephalalgia, a journal covering aspects of headache, published on behalf of the International Headache Society.

"MOH is associated with severe disability, unmet treatment need and little clinical data to support current management strategies," says David W. Dodick, M.D., Neurology, Mayo Clinic in Arizona, lead author of the main paper.

At one time called "rebound headaches", MOH are drug-induced headaches (or those caused by misuse of medications) that occur daily or near-daily, and typically develop over time, according to Dr. Dodick. A tolerance to the medication is built up, and then, "When the patient tries to discontinue the medication, difficult withdrawal symptoms can occur," he adds. Left untreated, some researchers believe that such headaches can have a greater impact on the patient’s daily functioning than migraines.

MOH can start out with a severe headache upon awakening and be accompanied by nausea, anxiety, forgetfulness and irritability. Overuse of some medications can result in daily migraine-like headaches or an increase in migraine frequency, according to the study. Co-author of the main paper, Stephen Siberstein, M.D., Jefferson Medical College of Thomas Jefferson University, says, "We don’t know what the mechanism of MOH is. We don’t know why some people get it, and others don’t."

There is speculation that the problem may occur when patients with severe pain go to extremes to relieve the pain so that they can perform their daily activities, or they attempt to get on top of the pain early in an attack, which could result in overusing the medications.

Some headache experts choose to prescribe drugs that prevent migraine to patients with MOH to guide them through the transition period while weaning them from the near-daily use of pain medications. Importantly, the paper advises that there is "an urgent need for more research" to better understand and manage the problem.

"Physicians need to be vigilant about what medications they prescribe for migraine and other kinds of headaches, and what over-the-counter medication patients are taking," suggests Dr. Dodick, who is president-elect of the American Headache Society and Professor of Neurology at Mayo Clinic Arizona.

Prevalence of MOH in the general population is at least 1 percent in adults and 0.5 percent in adolescents.

The study concludes that the best strategy to address MOH is to prevent overuse of medications through effective physician/patient communication and careful withdrawal of the overused medications. Mayo Clinic and the American Headache Society call for more research and development of improved treatment strategies for MOH.

(Source: Cephalalgia: Mayo Clinic: January 2009)