Chronic migraine and medication-overuse headache

Abstract

Many medications that people take for migraine headaches can actually make headaches worse, if the medications are taken too frequently. When this occurs, the resulting problem is called “medication-overuse headaches.” Unfortunately, when medication-overuse headaches occur, they can be difficult to treat. You can read more about migraine headaches and medication-overuse headaches on the next page. ### How can medication-overuse headaches be treated? In this issue of Neurology , Zeeberg and colleagues1 looked at the effect of a 2-month drug-free period in patients suffering from probable medication-overuse headache. They closely followed 337 patients seen at the Danish Headache Center with medication-overuse headache. The goal was to see the effects on headache frequency solely by eliminating the suspected culprit acute medication. Of the 337 patients who had their medications abruptly withdrawn, 64% (216 patients) were able to stay medication-free for 2 months. The researchers found that overall, 45% of the patients had improved in 2 months, 48% had no change, and only 7% had more headaches. ### Does the original headache type leading to probable medication-overuse headache determine response to acute medication withdrawal? Of the 216 patients with medication-overuse headache, the original headache types leading to overtreatment included migraine (10%), tension-type headache (33%), both migraine and tension-type headache (43%), and other (14%). Importantly, a previous diagnosis of migraine appeared to predict a better response to medication withdrawal. Patients with migraine only initially enjoyed a 67% reduction in headache frequency. …