Medication-overuse Headache: Diagnostic Criteria, Epidemiology, and Treatment

Abstract

Regular and frequent use of acute or symptomatic medications can worsen headaches and cause chronification of headache or medication-overuse headache (MOH). Although MOH is a burdensome medical condition because of disability in individual and socioeconomic aspects, difficulty in treatment, and frequent recurrence, even epidemiologic research is insufficient. Educating patients, general population, and healthcare providers about MOH is important in the first step to reducing the burden of MOH. In addition, preventing the occurrence of MOH is essential for the management of patients with a primary headache disorder. Physicians should educate and counsel the patients with MOH to stop or at least reduce the intake of acute or symptomatic medications. Withdrawal symptoms such as headache, nausea, and vomiting can be manageable with the bridging therapy using steroid or anti-emetic agents during or after the discontinuation of the overused medications. The promising efficacy of botulinum toxin A and calcitonin gene-related peptide monoclonal antibodies in the treatment of MOH have been published in the past few years. Evidencebased preventive therapies might be helpful in patients with MOH for both discontinuation of the overused medication and prevention of relapse. A comprehensive and multidisciplinary approach would improve the outcome for patients with MOH.