Abstract
Medication overuse headache (MOH) is a chronic secondary headache disorder attributed to the frequent or regular use of analgesics or acute antimigraine drugs in patients with a primary headache disorder. In addition, it has been linked to substance use disorder (SUD) also known as drug addiction, a persistent use of drugs or substances, despite substantial damage and adverse consequences, diagnosed by DSM-V criteria. At this time, apart from opioids, acute headache medications are not included in SUD. Despite the idea that the compulsive search for reward in MOH is similar to that observed in substance dependence, the DSM-V SUD criteria have never been carefully applied to MOH. We propose to discuss each DSM-V criterion of SUD diagnosis to see whether it is appropriate to use in MOH. We considered it was not-applicable when dealing with a situation that could be explained both by addictive behavior and by poorly controlled primary headache. We conclude that the SUD criteria should not be applied to patients who meet the criteria for MOH.
Highlights
Medication overuse headache (MOH) is a common chronic secondary headache disorder attributed to the frequent or regular use of analgesics or acute antimigraine drugs in patients with a primary headache disorder
The diagnosis of MOH is based on the International Classification of Headache Disorders 3rd edition (ICHD-3) 8.2 MOH is defined as: headache occurring for 15 or more days/month in a patient with a pre-existing primary headache and regular overuse of acute or symptomatic headache medication for 10 or 15 or more days/month, for more than 3 months.[2]
We reviewed the definitions of: overuse, misuse, abuse, dependence, addiction, tolerance and withdrawal, and suggest a new classification system for patients with frequent acute headache medication use
Summary
Applicability of DSM-V substance use disorder (SUD) criteria in medication overuse headache (MOH). Thaiza Agostini Córdoba de Lima[1 ], Mario Fernando Prieto Peres1,2 , Stephen D Silberstein[3]. Mario F P Peres; Hospital Israelita Albert Einstein; Av. Albert Einstein, 627, Bloco A1, 1o andar, Sala 110, Jardim Leonor; 05652-900, São Paulo-SP, Brazil.
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