Abstract
Medication overuse headache (MOH) usually resolves after the overuse is stopped and starting prophylactic medications. However, it can be challenging to prescribe common prophylactic medications when patients have a history of side effects. As an alternative therapy, traditional Japanese herbal kampo medicine can be used. We herein report a case of a MOH woman with a history of side effects by such common prophylactic medications. A 50-year-old woman presented with a severe migraine attack. She had suffered from migraines for 10 years. She had taken loxoprofen and sumatriptan every day for over eight years. As prophylactic medications, lomerizine, valproic acid, and amitriptyline had been prescribed in the past, but they were discontinued due to side effects. Therefore, she could continue only propranolol as prophylactic medication. She had severe pulsatile headaches and nausea every day. We diagnosed triptan- and non-steroidal anti-inflammatory drug-overuse headache (the International Classification of Headache Disorders 3rd edition code 8.2.2 and 8.2.3.2) and chronic migraine (code 1.3). She was admitted and stopped loxoprofen and sumatriptan. We prescribed three types of Japanese herbal kampo medicines - kakkonto (TJ-1), goreisan (TJ-17), and goshuyuto (TJ-31). Her headache was relieved on day 5, and she was discharged on day 7. In the 40 days after discharge, she had only three times mild headaches with a numeric rating scale (NRS) of 2/10. She did not need any triptans nor anti-inflammatory drugs. We herein presented the MOH woman who was successfully treated using three types of kampo medicine. We should pay attention to their side effects, but kampo medicine may be useful for MOH treatment as acute and prophylactic medications for primary headaches.
Highlights
Medication overuse headache (MOH), the International Classification of Headache Disorders 3rd edition (ICHD-3) code 8.2, is a condition in which headache occurring on 15 or more days per month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication for more than three months
It can be challenging to prescribe common prophylactic medications like anticonvulsants, antihypertensive drugs, or antidepressants when patients have a history of side effects from those prophylactic medications, such as hypotension, drowsiness, and allergies
We report a MOH woman with a history of side effects from such common prophylactic medications. Her MOH was successfully relieved by kampo medicine instead of the common prophylactic medications
Summary
Medication overuse headache (MOH), the International Classification of Headache Disorders 3rd edition (ICHD-3) code 8.2, is a condition in which headache occurring on 15 or more days per month in a patient with a pre-existing primary headache and developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more or 15 or more intakes days per month, depending on the medication) for more than three months. Considering the history of the side effects using the common prophylactic medications, we prescribed three packets of kakkonto (TJ-1) [4], goreisan (TJ-17) [5,6], and goshuyuto (TJ-31) [7,8] per day These kampo medicines are sometimes used in Japanese clinical practice and described as an alternative therapy in the Japanese Clinical Practice Guideline for Chronic Headache 2013 [2]. In the 40 days after discharge, she had only three times mild headaches with NRS 2/10, which could be relieved by kakkonto (TJ-1) and goreisan (TJ-17) intake as needed They are used as prophylactic medications, and she took them when she felt a headache coming on.
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