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A high frequency of drug intake to manage headache pain may mean that you have a condition known as medication overuse headache (MOH). According to the International Headache Society, MOH may exist when the following criteria are fulfilled: (1) there is headache on 15 or more days a month; (2) pain characteristics are dull, and of light to moderate intensity on both sides of the head; (3) drug intake includes ergots, triptans and opioids (these drugs are discussed below) for 10 or more days...
A high frequency of drug intake to manage headache pain may mean that you have a condition known as medication overuse headache (MOH). According to the International Headache Society, MOH may exist when the following criteria are fulfilled: (1) there is headache on 15 or more days a month; (2) pain characteristics are dull, and of light to moderate intensity on both sides of the head; (3) drug intake includes ergots, triptans and opioids (these drugs are discussed below) for 10 or more days per month, simple painkillers 15 days or more for a minimum of 3 months; and (4) the headache disappears after withdrawal.
Researchers from the Department of Neurology, University Hospital Essen, Germany reviewed MOH in the August 2004 issue of the medical journal Lancet Neurology. The researchers suggest that up to four percent of the population overuse painkillers and other drugs for treatment of conditions such as migraine headache and that about one percent of the population in Europe, North America, and Asia have medication overuse headache.
The characteristics of medication overuse headache are summarized in the table below.
Characteristics Of Medication Overuse Headache General Symptoms and Observations
Associated Symptoms
Special Symptoms with Ergot Overuse (see the list of ergot drugs accompanying this article)
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According to the review, there is now substantial evidence that all drugs used for the treatment of headache can cause MOH in patients who are using drugs to treat their headache. Two families of migraine headache drugs, the ergot derivatives and the “triptans”, are associated with the development of MOH. The table below lists some of the ergot and “triptan” drugs.
WARNING: Ergot-Containing Migraine Headache Drugs Do not take ergotamine and caffeine if you are taking antifungals such as itraconazole (SPORANOX) and ketoconazole (NIZORAL); clarithromycin (BIAXIN); erythromycin (E.E.S., E-MYCIN, ERYTHROCIN); HIV protease inhibitors such as indinavir (CRIXIVAN), nelfinavir (VIRACEPT), and ritonavir (NORVIR); or troleandomycin (TAO). Dihydroergotamine (D.H.E. 45, MIGRANAL) “Triptan” Migraine Headache Drugs:
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Even simple painkillers such as aspirin (BAYER ASPIRIN) and acetaminophen (TYLENOL) can induce MOH. Likewise, the narcotic or opioid painkillers that are derivatives of morphine, and codeine and combination products containing butalbital, caffeine, or aspirin with or without codeine can cause MOH. Some common brand names of combination products are FIORICET with CODEINE, FIORINAL with CODEINE, ESGIC, FIORICET, and FIORINAL.
A high frequency of regular drug use to manage headache does not always mean MOH. There are some chronic headache disorders and medical conditions in which patients have chronic headache, not MOH. These conditions are listed in the table below.
Conditions That Can Cause Chronic Headache Chronic Migraine: a type of migraine that increases in frequency over time and occurs more than 15 days per month Chronic Tension Type Headache: pain intensity is lower than that of a migraine and has occurred on 15 days a month for at least six months Hemicrania Continua: daily headache of moderate intensity; commonly associated with sudden onset short pain New Daily Persistent Headache: does not typically respond to ergots, triptans, or simple painkillers Cerebral Venous and Sinus Thrombosis: blood clots in the large veins lying within the skull cavity Giant Cell Arteritis: inflammation of medium-sized arteries; headache usually on one side and does not respond to headache medications |
The authors of the review support drug withdrawal as the treatment of choice for MOH. We agree. Drug withdrawal strategies vary. Most physicians prefer undertaking withdrawal while the patient is hospitalized. In some situations, withdrawal may be attempted in the outpatient setting.
What You Can Do
You should contact your physician if you are using one of the drugs mentioned above and you exhibit the characteristics of medication overuse headache given above.
