Prevalence Of Medication Overuse Headache Research Articles

Complicated Form of Medication Overuse Headache Is Severe Version of Chronic Migraine.

Background: MOH (medication overuse headache) is regarded as a complication of chronic migraines (CMs), with a general acknowledgment of reciprocal triggering between these two conditions. The present study aims to investigate the clinical parameters of relevance for the development of MOH among patients with CM, as well as for the subtype classification of MOHs. Method: We compared two groups of CM patients, with and without MOH, separated based on their demographic data and migraine characteristics. A subgroup of MOH accompanied by psychiatric co-morbidities (depression, anxiety, sleep disorder) was delineated, and the clinical features of relevance for the progression of MOH into the complicated state were evaluated. Results: The study revealed a higher prevalence of a family history of migraine in both the MOH and potentially complicated MOH subgroups (p < 0.001, p = 0.036), along with a higher prevalence of bilateral pain localization (p = 0.033, 0.021). Symptoms commonly associated with migraines, such as nausea, vomiting, photophobia, phonophobia, and osmophobia, were more common in both the MOH and potentially complicated MOH subgroups (p < 0.05). Furthermore, a positive correlation was found for the frequency (p < 0.001) and severity (p = 0.010) of migraine attacks and the duration of headaches (p = 0.007), atopy (p = 0.017), sleep disturbances (p = 0.011), and emotional stress (p = 0.022) in the MOH group. Conclusion: We found a positive correlation between the prevalence of MOH among patients with CM and a family history of migraines, higher frequency and intensity of headaches, bilateral manifestation, sleep disturbances, and emotional stress. Moreover, symptoms accompanying migraines were found to be more prevalent in individuals with MOH and potentially complicated MOH.

Unsatisfactory response to acute medications does not affect the medication overuse headache development in pediatric chronic migraine

BackgroundChronic migraine (CM) negatively impacts the quality of life of 2 to 4% of pediatric patients. In adults, CM is frequently linked to medication overuse headache (MOH), but there is a much lower prevalence of MOH in children. A suboptimal response to acute therapies may lead to their reduced use, thus preventing MOH development in children and adolescents. The frequency of patients with CM who do not respond to acute therapies was examined in the present study. We investigated whether the prevalence of MOH was different between responders and non-responders. We also examined whether patients receiving prophylactic therapy had an improved response to acute therapy. Finally, we investigated if there was a difference in the frequency of psychiatric comorbidities between responders and non-responders.MethodsWe retrospectively analysed clinical data of all chronic pediatric migraineurs under the age of 18 referred to the Headache Centre at Bambino Gesù Children Hospital in June 2021 and February 2023. ICHD3 criteria were used to diagnose CM and MOH. We collected demographic data, including the age at onset of migraine and the age of the CM course. At baseline and after 3 months of preventive treatment, we evaluated the response to acute medications. Neuropsychiatric comorbidities were referred by the children’s parents during the first attendance evaluation.ResultsSeventy patients with CM were assessed during the chosen period. Paracetamol was tried by 41 patients (58.5%), NSAIDs by 56 patients (80.0%), and triptans by 1 patient (1.4%). Fifty-one participants (73%) were non-responder to the abortive treatment. The presence of MOH was detected in 27.1% of the whole populations. Regarding our primary aim, MOH was diagnosed in 29% of non-responder patients and 22% of responders (p > 0.05). All patients received preventative treatment. After 3 months of preventive pharmacological therapy, 65.4% of patients who did not respond to acute medications achieved a response, while 34.6% of patients who were non-responder remain non-responder (p < 0.05). Prophylactic therapy was also effective in 69% of patients who responded to acute medication (p < 0.05). Psychiatric comorbidities were detected in 68.6% of patients, with no difference between responders and non-responders (72.2% vs. 67.3%; p = 0.05).ConclusionsDespite the high prevalence of unresponsiveness to acute therapies in pediatric CM, it does not act as a protective factor for MOH. Moreover, responsiveness to acute drugs is improved by pharmacological preventive treatment and it is not affected by concomitant psychiatric comorbidities.

Medication Overuse Headache: an Updated Review and Clinical Recommendations on Management.

Medication overuse headache (MOH) is highly prevalent among individuals with primary headache disorders. (1) Provide an update on epidemiology, risk factors, and treatment strategies of MOH and (2) provide recommendations on the management of MOH. The prevalence of MOH ranges from 0.5 to 7.2%. Risk factors for MOH include female sex, lower socioeconomic status, some psychiatric conditions, and substance use disorders, among others. Recent large clinical trials support preventative therapy as an integral component of MOH management. Emerging clinical trial evidence supports anti-CGRP mAbs as effective preventative treatments among individuals with migraine and MOH. Among the large clinical trials, candesartan, topiramate, amitriptyline, and onabotulinumtoxinA were the most used preventative therapies, providing further support for these agents. MOH management requires a multifaceted and patient-centered approach that involves patient education, behavioral interventions, withdrawal of the overused medication, and initiation of preventative medication.

Assessment of the Prevalence and Level of Awareness of Medication Overuse Headache Among the General Population in Makkah City, Saudi Arabia.

Medication overuse headache (MOH) is a secondary headache condition caused by consistently using more medication than necessary to treat headache symptoms. MOH is defined as a headache that occurs for 15 or more days per month in a patient with a pre-existing primary headache, and it develops as a result of regular overuse of symptomatic headache medication for more than three months. Patients with headaches often use simple pain medicationfor 15 or more days per month (e.g., non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol) and 10 or more days per month of opioids,triptans, and combination analgesics, but when there is no relief from these medications, the headache progression can lead to a cycle of consuming more medication with increased pain, which can lead to MOH. This study aimed to assess the prevalence and awareness of MOH among the general population of Makkah, Saudi Arabia. A cross-sectional study was conducted between December 2022 and March 2023 using a self-administered online questionnaire disseminated through social media. Data were collected from females and males 18 years of age and older living in Makkah, Saudi Arabia. Overall, 715 individuals completed the questionnaire, 497 of whom were female (69.5%). The average age of the participants was 32.9 years (±13.3 years). The prevalence of MOH among those who reported having experienced headaches throughout their lifetimes was estimated to be 4.5%. Only 134 people (18.7%) were determined to be aware ofMOH. This study demonstrated that the general population of Makkah has a high prevalence of MOH and low levels of MOH awareness.

The Prevalence and Level of Awareness of Medication Overuse Headache in Qassim Province, Saudi Arabia: A Cross-Sectional Study.

IntroductionMedication overuse headache (MOH) is a secondary headache caused by regular overuse of medication(s) intended to relieve (notably, not prevent) the symptoms of a pre-existing primary headache (most commonly, migraine and tension headaches). MOH places a considerable burden on both patients and society. Understandably, the disorder is the subject of many cross-sectional studies worldwide. Research on MOH in Qassim province, Saudi Arabia, however, has not been conducted; therefore, the present study aims to identify the prevalence and level of awareness of MOH in Qassim province.MethodsAn observational cross-sectional study was conducted in Qassim province from July 1, 2021, to June 13, 2022. A modified electronic questionnaire was distributed through social media platforms. The questionnaire covers demographics, prevalence of MOH, and awareness of MOH. Prevalence was measured using a scoring system based on the criteria of the International Classification of Headache Disorders, third edition (ICHD-3) for diagnosing MOH.ResultsA total of 499 people completed the questionnaire, 286 (57.3%) of whom were female and 213 (42.7%) of whom were male. The majority of the participants were Saudi nationals (95.4%). The mean age of the participants was 35 years old (± 12.7 years). Out of the 499 participants, 451 (90.4%) reported that they had experienced headaches in their life. The prevalence of MOH among those who had reported headaches was 4%, compared with a level of awareness of MOH among all the participants of 18%.ConclusionAccording to our study, there is a high prevalence of MOH in Qassim province. This is also coupled with a high awareness of MOH.

Questionnaire-based survey on the prevalence of medication-overuse headache in Japanese one city-Itoigawa study.

ObjectiveThe medication-overuse headache (MOH) prevalence has not been investigated in a general Japanese population. We performed questionnaire-based survey and revealed MOH prevalence and its characteristics. We also performed clustering to obtain insight for MOH subgrouping.MethodsIn this cross-sectional study, the 15–64-year-old population was investigated in Itoigawa during their COVID-19 vaccination under the national policy. MOH was defined as ≥ 15 days/month plus self-report of use of pain medications ≥ 10 or 15 days/month in the last 3 months. Ward method and k-means + + were used to perform clustering MOH patients.ResultsAmong 5865 valid responses, MOH prevalence was 2.32%. MOH was common among females and the middle-aged. Combination-analgesic is the most overused as 50%. MOH had aggravation by routine physical activity, moderate or severe pain, and migraine-like, compared to non-MOH. The 136 MOH patients could be grouped into 3 clusters. Age and frequency of acute medication use were essential factors for clustering.ConclusionsThis is the first study of MOH prevalence in Japan. Most MOH characteristics were similar to previous reports worldwide. Public awareness of proper headache treatment knowledge is still needed. Clustering results may be important for subtype grouping from a social perspective apart from existing clinical subtypes.

Medication overuse headache in patients with chronic migraine using cannabis: A case-referent study.

To examine whether cannabis use predicts medication overuse headache (MOH) in patients with chronic migraine (CM). Electronic chart review was conducted by combining the terms "CM," "medication overuse," "cannabis," "cannabidiol," and "tetrahydrocannabinol" for patients seen at our headache clinics from 2015 to 2019. Of 729 charts consecutively screened, 368met our inclusion criteria, that is, adult patients with CM with ≥1-year CM duration. The following variables were extracted from the included patient charts: MOH diagnosis, age, sex, migraine frequency, current CM duration, current cannabis use duration, overused acute migraine medications, current MOH duration, and types of cannabis products used. Logistic regression was used to identify variables predicting MOH while controlling for remaining predictors. Agglomerative hierarchical clustering (AHC) was conducted to explore natural clusters using all predictor variables. There were 212 patients with CM and MOH (cases; median age 43years, interquartile range [IQR] 33-54; 177 [83%] females) and 156 patients with CM without MOH (referents; median age 40years, IQR 31-49; 130 [83%] females). MOH was present in 81% (122/150) of current cannabis users compared with 41% (90/218) in those without cannabis use-adjusted odds ratio 6.3 (95% CI: 3.56 to 11.1, p< 0.0001). Current cannabis use was significantly associated with opioid use (Spearman's rho 0.26, p<0.0001). Both current cannabis use (rho 0.40, p<0.0001) and opioid use (rho 0.36, p<0.0001) were significantly associated with MOH. Similarly, AHC revealed two major natural clusters. Cluster I patients featured 9.3 times higher current cannabis use, 9.2 times higher current opioid use, and 1.8 times higher MOH burden than those in Cluster II (p<0.0001). Cannabis use was significantly associated with increased prevalence of MOH in CM. Bidirectional cannabis-opioid association was observed-use of one was associated with use of the other. Advising patients with CM and MOH to reduce cannabis use may help treat MOH effectively.

Monitoring chronic headache and medication-overuse headache prevalence in Denmark.

To study chronic headache and medication-overuse headache (MOH) prevalence; to identify groups with high prevalence of these conditions; and to identify the most frequently used pain medications among respondents with chronic headache. Chronic headache and MOH prevalence in Denmark were last estimated in 2010. In this cross-sectional study, 104,950 individuals aged ≥16 years were randomly sampled for the 2017 Danish Capital Region Health Survey. Responses to questions about headache and use of acute pain medications were linked to demographic registries. MOH was defined as headache ≥15 days/month plus self-report of use of pain medications ≥10 or 15 days/month, in the last three months. Weighted prevalence proportions were calculated. Among 55,185 respondents, chronic headache prevalence was 3.0% (95% CI: 2.3-3.2) and MOH prevalence was 2.0% (95% CI: 1.8-2.1). Both conditions were more common among females and the middle-aged. Respondents on social welfare or receiving early retirement pensions had the highest prevalences. Among those with chronic headache, 44.7% overused over-the-counter analgesics for headache; paracetamol 41.5%; a combination of different pain relievers 25.3%; ibuprofen 21.9%; opioids 17.0%; combination preparations 14.3%; and triptans 9.1%. The highest prevalence of chronic headache and MOH was seen among people with low socioeconomic position. Overuse of paracetamol was most common. Reported opioid use was higher than expected. Groups with high prevalence of MOH should be the focus of public health interventions on rational use of OTC and prescription pain medications.

Neuroimaging Findings in Patients with Medication Overuse Headache.

Medication overuse headache (MOH) is a secondary headache syndrome defined as the deterioration of the headache associated with the overuse of analgesics. The prevalence of MOH is 1-2% in the general population and even up to 50% in special clinics. Overuse of abortive medications is highly associated with chronic daily headaches and also a known risk factor for headache evolution. Possible mechanisms include neural plasticity changes such as sensitization and defective endogenous pain inhibition. Psychological studies have suggested dependence, even addiction, in patients with MOH. Neuroimaging studies have provided valuable information concerning MOH pathophysiology. Magnetic resonance imaging analyzed by voxel-based morphometry showed gray matter volume changes in brain areas participating the pain modulations. Changes of brain function at similar areas have been revealed by positron emission tomography and functional magnetic resonance imaging studies. Many of these changes were correlated with either headache and/or analgesics parameters such as frequency and duration. These changes are typically reversible after successful treatment. Though the cause or consequence debate remains unsettled, we are more in favor of these findings as maladaptive changes to the frequent headaches or medication overuse. Of these brain areas involved in MOH, orbitofrontal cortex is of interest in several ways. In an early positron emission tomography study, the hypometabolism persists after successful treatment which implied a causal role. The following morphological studies showed the orbitofrontal cortex volume could predict treatment responses. Functional magnetic resonance imaging studies, task positive and also resting-state ones, also reported changes within the mesocorticolimbic dopamine system, also known as reward system. Important brain areas of this system include ventral tegmental area, striatum, and orbitofrontal cortex. The system plays an important role in decision-making, dependence, and addiction, as implicated in psychological studies of MOH. Further studies on neuromodulation of this system may be considered in the treatment of MOH.

Medication-overuse headache: risk factors, pathophysiology and management.

Medication-overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder that occurs on ≥15 days per month for >3 months, and is caused by overuse of medication intended for acute or symptomatic headache treatment. The prevalence of MOH in the general population is around 1%, but the condition is much more common in people with headache, in particular chronic migraine. The phenotype of the headache in MOH depends on the initial primary headache and the type of overused acute medication. In this Review, we will discuss the epidemiology, risk factors, pathophysiology, prevention and treatment of MOH. Treatment of MOH is performed in three steps: educating patients about the relationship between frequent intake of acute headache medication and MOH with the aim to reduce intake of acute medication; initiation of migraine prevention (such as topiramate or onabotulinumtoxin A in migraine) in patients who fail step 1; detoxification on an outpatient basis or in a day hospital or inpatient setting, depending on severity and comorbidities. The success rate of treatment is around 50-70%, although patients whose MOH is associated with opioid overuse have higher relapse rates. In all patients with MOH, relapse rates can be reduced by patient education and care in the follow-up period.

Study of the use of analgesics by patients with headache at a specialized outpatient clinic (ACEF).

To evaluate the use of analgesics in headache diagnosed in Outpatients Headache Clinic (ACEF), as well as his involvement in the activities of the patients. 145 patients with headache seen at ACEF during the period August/July 2009/2010 underwent a questionnaire and interview with neurologist responsible for the final diagnosis according to ICHD-II. Relationship Women:Men 7:1. 1) Prevalence: Migraine without aura (52.4%), migraine with aura (12.4%), chronic migraine (15.2%) and medication overuse headache (MOH) (20%). 2) Analgesic drugs used: Compounds with Dipyrone (37%), Dipyrone (23%), Paracetamol (16%) compound with Paracetamol (6%), triptans (6%) and non steroidal anti-inflammatory drugs (12%). There was a significant decrease in the duration of pain and less interference in the activities of the headache patients after the use of analgesics. Prevalence of MOH has been increasing in population level and specialized services. New studies emphasizing the MOH are needed to assist in the improvement of their diagnostic and therapeutic approach.

Can we know the prevalence of MOH?

The Global Burden of Disease Survey 2010 (GBD2010) reaffirmed the importance of migraine as a cause of public ill-health and disability (1). It did this beyond doubt, and was welcomed (2). But whereas migraine is neither the most prevalent nor the most disabling of headache disorders, others that may be of similar importance remain largely overlooked. The earlier GBD2000 considered only migraine (3). GBD2010 at least included tension-type headache (TTH), finding it the second most common disease in the world (behind dental caries; migraine was third). But, with ictal disability estimated at just 4% (against 43.3% for migraine), TTH accounted for only 0.25% of all years of life lost to disability (YLDs) (against 3.1% for migraine) (1). Medication-overuse headache (MOH), heavily burdensome at the individual level (4) and very common in headache clinics, did not make the final analysis in GBD2010 (1). Nevertheless it was included in the worldwide consultation undertaken by GBD2010, comparing the various health states attributable to disease, and was allocated a disability weight of 22% (unpublished data). Assuming a global prevalence of 1.5% and headache present on most days (say 60%), a back-of-the-envelope estimate of total YLDs attributable toMOH comes in at about two-thirds of those caused by migraine – about 2%of all YLDs. I do not offer this as an accurate assessment, but do believe it demonstrates that MOH is a far from insignificant cause of public ill-health and disability. In health-policy terms, its importance is magnified not only because it consumes very substantial health-care resources (4) but also, sinceMOH is an avoidable condition, because this cost is unnecessary. MOH was omitted from the reports of GBD2010 (1), principally because prevalence data from around the world were inadequate to support regional estimates. This was true but is changing, and future iterations from GBD2013 onwards can be expected to include it. But do we know its prevalence? Population-based studies have not been easy because of two related problems: of case definition and case ascertainment. The definition of MOH has been unstable from the time of its recognition; diagnostic criteria have changed through the various editions of the International Classification of Headache Disorders (ICHD) (5–8), while alternative proposals (9) have led to an epidemiologically unhelpful conflation of MOH with chronic migraine. In this issue of Cephalalgia, Westergaard et al. directly confront one of these problems and offer proposals to overcome the other (10). They base their arguments on published studies of MOH prevalence, finding, from a systematic literature search, 27 reports of 24 datasets from 16 countries. Diagnostic criteria in these studies, they note, closely followed the consensus of their time. Perhaps surprisingly, therefore, estimates of adult prevalence clustered around 1–2%, although a few were much higher (up to 7.2%). What this may indicate is greater consistency in the criteria applied by most authors of these studies than existed in the definitions of the time, the result, probably, of pragmatic adaptations. Westergaard et al. want to make this approach explicit. ‘Diagnostic criteria that are useful in the clinic’, they observe, ‘are not always applicable in population-based research’. For example, demonstration of causation – a general requirement in ICHD for secondary headaches – and exclusion of other possible diagnoses demand careful evaluation beyond the means of the epidemiological researcher. The unspoken concern here is that, unless accepted diagnostic criteria are applicable in population-based research, prevalence can never be known. Westergaard et al. find the past experience of adapting criteria instructive as a guide for how future population-based studies can use ICHD-3 beta (8), and propose alternative criteria for MOH specifically for such studies. Essentially these omit criterion C. ‘Exclusion of other headache diagnoses cannot be easily implemented’, they argue, ‘and should not hinder efforts to estimate prevalence’.

Definitions of medication-overuse headache in population-based studies and their implications on prevalence estimates: A systematic review

Case definitions of medication-overuse headache (MOH) in population-based research have changed over time. This study aims to review MOH prevalence reports with respect to these changes, and to propose a practical case definition for future studies based on the ICHD-3 beta. A systematic literature search was conducted to identify MOH prevalence studies. Findings were summarized according to diagnostic criteria. Twenty-seven studies were included. The commonly used case definition for MOH was headache ≥15 days/month with concurrent medication overuse ≥3 months. There were varying definitions for what was considered as overuse. Studies that all used ICHD-2 criteria showed a wide range of prevalence among adults: 0.5%-7.2%. There are limits to comparing prevalence of MOH across studies and over time. The wide range of reported prevalence might not only be due to changing criteria, but also the diversity of countries now publishing data. The criterion "headache occurring on ≥15 days per month" with concurrent medication overuse can be applied in population-based studies. However, the new requirement that a respondent must have "a preexisting headache disorder" has not been previously validated. Exclusion of other headache diagnoses by expert evaluation and ancillary examinations is not feasible in large population-based studies.

A clinical study on medication overuse headache in childhood and adolescence

There are few studies on Medication Overuse Headache (MOH) in children and no epidemiological studies on an Italian population. We evaluated the prevalence of MOH in patients referred to our Center in 2011.

Medication Overuse Headache in School‐Aged Children: More Common Than Expected?

To investigate the prevalence of medication overuse headache (MOH) in a group of children and adolescents seen for headache in a third-level center in Italy. Epidemiological studies indicate a prevalence of MOH in children and adolescents between 0.3 and 0.5%; no data are available for the Italian population. We studied a group of first-seen children and adolescents (118 patients, 43.2% male and 56.8% female, mean age: 11.9 years). A detailed history was taken, using criteria defined by Olesen et al to assess the presence of MOH. Statistical correlations between demographic and diagnostic variables were assessed. Eleven (9.3%) of our patients presented MOH; in the group with chronic daily headache, the prevalence raised to 20.8%. At follow up, after introduction of a more rationale treatment, most patients improved, but 2 of them reported a worsening of their headache. We believe that a strong warning regarding medication overuse in headache therapy is essential for pediatricians and neuropsychiatrists.

Prevention and management of medication overuse headache

This review provides an update on our knowledge regarding prevention and management of medication overuse headache (MOH). The prevalence of MOH is 1-2% in the general population worldwide, and because of the tremendous socio-economic cost, it is likely to be the most costly neurological disorder known. MOH has similarities with traditional drug addiction. Use of a brochure on medication overuse can prevent MOH. The Severity of Dependence Scale (SDS) score is a significant predictor of medication overuse among headache patients. Withdrawal of medication is essential in the management of MOH, and simultaneous initiation of prophylactic medication may alleviate this process. Short advice on medication overuse by a physician reduced mean medication days from 22 to 6 days; 76% no longer had medication overuse and 42% no longer had chronic headache. A brochure and/or the SDS should be used to prevent MOH. Withdrawal is the cornerstone of MOH management. Short advice on MOH is the current most cost effective management method, a method that can be applied anywhere including third world countries.

Epidemiology of medication overuse headache in the general Swedish population

The aim was to estimate the prevalence of medication overuse headache (MOH) in Sweden and to analyze the occurrence of this disorder in different population groups. A total of 44,300 randomly selected individuals (55% women), aged 15 years and above, were interviewed in a national telephone survey, using a standardized questionnaire including the International Headache Society criteria for MOH and questions about sociodemographic factors, headache history and medication use. In Sweden, 3.2% (95% confidence interval (CI) 3.1-3.4), n = 1428) suffer from chronic daily headache (CDH) and out of those, 56% (n = 799) have MOH. The prevalence of MOH is 1.8% (95% CI 1.7-1.9). The mean age of onset was higher among men than women as well as among those with tension-type headache as primary headache compared to those who originally had migraine. A multivariate analysis showed that socioeconomic factors such as having a low level of education and/or a low household income were associated with MOH. This is the first Swedish population-based study of MOH and we conclude that MOH is a significant public health problem in Sweden, as it is in other parts of the world.

Medication overuse headache

Medication overuse headache (MOH) has developed into the third most common type of headache after tension-type headache and migraine. The prevalence of MOH is ∼ 1% of the world’s population and it shows an increasing trend as recent studies reveal a common involvement throughout the ages, even starting in childhood. All antiheadache drugs, such as triptans, analgesics, ergots and opioids, along with the common combination substances currently on the pharmacological market are capable of inducing MOH. New data on specific clinical features and mean critical monthly dosages and mean critical monthly intake frequencies are now available. The only effective treatment concept is consequent withdrawal therapy. Data of prospective studies on relapse rates and predictors of relapse after successful withdrawal therapy are presented.

Medication-overuse headache

Medication-overuse headache (MOH) can be caused by almost all anti-headache drugs including analgesics, ergots, triptans, and combined preparations The prevalence of chronic daily headache (CDH) appears to be between 2% and 4% in the general population. Current epidemiologic studies suggest that MOH accounts for approximately 50% of these cases. The pathophysiology of MOH remains unclear. The only therapy is withdrawal from the overused substances. Prednisone decreases the duration of headache in the first days of withdrawal therapy. The only strategy to reduce the prevalence of MOH is to prevent the development of MOH in the first place by restriction of anti-headache drugs and constant education of patients.