There is a critical need to review current treatment strategies for the increasingly common problem of medication overuse headaches (MOH), according to a series of international papers in the November issue of Cephalalgia.
"MOH is associated with severe disability, unmet treatment need and little clinical data to support current management strategies" says neurology expert Professor David W Dodick from the Mayo Clinic College of Medicine, Arizona, USA.
His overview also highlights the need for greater research into the condition - in particular the role that migraine medication can play in the withdrawal process. It is accompanied by papers on how the condition is tackled in Canada, Denmark, Germany, India, Moldova, Japan, Spain and Taiwan.
MOH, previously known as rebound headache, drug-induced headache or drug-misuse headache, is a headache that occurs at least 15 days a month when patients overuse medication.
"Tolerance to the analgesic effect of the acute medication develops over time, consumption may increase and patients may show withdrawal symptoms when they stop the overused mediation" explains Professor Dodick. "We estimate that the condition affects one in every 100 adults and one in every 200 adolescents worldwide, which is a considerable number.
"For example, in the USA 60 per cent of people with chronic daily headaches attending headache clinics have MOH. Data from a physician study suggests that it may be the third most frequent type of headache after migraines and tension-type headaches. And a Norwegian study found that people were seven times more likely to suffer from chronic headaches if they used analgesics daily or almost daily for more than a month."
Despite being very common, there are no standardised treatment guidelines for MOH, partly due to the small number of controlled clinical trials that have addressed the treatment of this condition.
However, recent research suggests that the traditional approach of not providing new treatment strategies until patients have been through detoxification may not be the best clinical option.
"Data from recent trials indicate that treatments developed to prevent migraine may prove effective if they are used in patients with MOH before the overused medicine is withdrawn" says Professor Dodick.
"This points to the need for clinical trials to re-evaluate current strategies and find the best way forward."
The international papers that accompany Dr Dodick's overview show that MOH is a common problem, but the incidence, causes and treatment vary from country to country.