What is Medication Overuse Headache?

Medication overuse headache, which is also known as medication-induced headache, is a type of headache that is caused by the frequent administration of analgesic or triptan medications that are often used to treat headaches or migraines.

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Characteristics

Medication overuse headaches occur very frequently; in fact, these headaches may present daily, every other day, or lead to a constant pain that does not appear to cease.  The following characteristics define the condition:

  • Symptoms of headache for at least 15 days/month
  • No improvement or worsening of symptoms with medication use
  • Regular use for at least three months of medication to treat headache

Additionally, the symptoms of this type of headache revert to the previous pattern of headaches that are considered to be normal for the individual within 8 weeks of complete cessation of the medications. For this reason, a certain diagnosis of medication overuse headache cannot be made until the symptoms have resolved, following the withdrawal of treatment.

Risk factors

Medication overuse headache is a common type of headache that affects approximately 2% of the population throughout their lifetime. Anyone can suffer from medication overuse headache; however, the incidence is higher in women and people between the ages of 30 and 50 years.

As this condition is caused by the frequent use of medications to treat headaches and migraines, individuals who suffer from recurrent and severe headaches are at the highest risk of developing a medication overuse headache. It is worth noting that the headache can also present when patients have been taking the medications as prescribed for their condition.

There is no particular dose or frequency that is associated with an increased risk of medication overuse headache, as the threshold can vary for each individual.

Medication Overuse Headache

Causative medications

There are several medications used to treat headaches that can lead to the presentation of medication overuse headache when used on a frequent basis. These include:

  • Codeine
  • Sumatriptan
  • Eletriptan
  • Zolmitriptan
  • Rizatriptan
  • Naratriptan
  • Almotriptan
  • Ergotamine
  • Ibuprofen
  • Aspirin
  • Naproxen
  • Diclofenac
  • Paracetamol

Of these, codeine and the triptan drugs are most likely to be associated with medication overuse headaches.

Management

The essential step in the treatment of medication overuse headache is to cease treatment with the causative medication. This typically worsens the symptoms of headache initially; however, over a period of a few weeks (up to 2 months), the headaches tend to reduce in frequency and fall back into a normal pattern of occurrence.

In most cases, it is recommended to stop taking the analgesic medications completely on a particular day, rather than gradually reducing the dose. This can be very uncomfortable at first, as the headache usually intensifies and withdrawal symptoms may present, such as:

  • Nausea
  • Diarrhea
  • Insomnia
  • Restlessness
  • Anxiety

These symptoms are particularly common when ceasing opiate medications like codeine.

It is important that the patient has access to a strong support network to help them through this period and encourage them to continue ceasing the medication use. Patients should understand that this step is necessary for the process of recovery but other techniques will be employed as symptoms improve.

After 2-8 weeks, the pattern of the headaches should revert back into their original pattern, with significantly less frequency. At this point, preventative treatment for the headaches can be commenced.

In some cases, changes to the medications in respect to before the onset of the medication overuse headaches may be warranted, such as substituting aggravating medications like codeine for less problematic medications like ibuprofen.

In the future, it is essential that patients know that they are susceptible to medication overuse headache and aware of the risk when they take medications frequently. Taking several doses a day for 1-2 days is acceptable;  however, it is recommended to use pain-relieving medications for two days or less in any given week. Prophylactic medications to prevent future headaches or migraines can be a good option to reduce the frequency of symptoms.

References

Further Reading

Last Updated: Dec 21, 2022

Yolanda Smith

Written by

Yolanda Smith

Yolanda graduated with a Bachelor of Pharmacy at the University of South Australia and has experience working in both Australia and Italy. She is passionate about how medicine, diet and lifestyle affect our health and enjoys helping people understand this. In her spare time she loves to explore the world and learn about new cultures and languages.

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