Medication Overuse Headache

What Is Medication Overuse Headache?

Medication overuse headache (MOH), also called rebound headache, develops when frequent use of headache medications paradoxically increases headache frequency. It affects 1-2% of the population.¹

At-Risk Medications²

• Simple analgesics - ≥15 days/month (aspirin, acetaminophen, NSAIDs)
• Triptans - ≥10 days/month
• Opioids - ≥10 days/month
• Combination analgesics - ≥10 days/month
• Ergotamines - ≥10 days/month

Warning Signs

• Headaches increasing in frequency
• Need more medication for relief
• Taking medication "just in case"
• Headache upon waking
• Headache returns as medication wears off
• Preventive medications not working

Who's at Risk

• People with migraine or tension headache
• Those using acute medications frequently
• More common in women
• Family history of headache
• Psychiatric comorbidities

Treatment³

Medication Withdrawal

• Stop overused medication (abrupt or tapered)
• Expect temporary worsening
• May need bridge therapy
• Takes 2-3 months for improvement

Prevention Strategies

• Start effective preventive medication
• Limit acute medications to <10-15 days/month
• Keep headache diary
• Behavioral approaches

References

1. Westergaard ML, Hansen EH, Glümer C, et al. Definitions of medication-overuse headache in population-based studies. Cephalalgia. 2014;34(6):409-425.
2. Headache Classification Committee. The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018;38(1):1-211.
3. Diener HC, Holle D, Solbach K, Gaul C. Medication-overuse headache: risk factors, pathophysiology and management. Nat Rev Neurol. 2016;12(10):575-583.