Medication overuse headache
From Wikipedia, the free encyclopedia
| Medication overuse headache | |
|---|---|
| Classification and external resources | |
| ICD-10 | G44.41, G44.83 |
Medication overuse headaches (MOH) , also known as rebound headaches usually occur when analgesics are taken frequently to relieve headaches. Rebound headaches frequently occur daily and can be very painful and are a common cause of chronic daily headache. They typically occur in patients with an underlying headache disorder such as migraines or tension headaches that "transforms" over time from an episodic condition to chronic daily headache due to more and more frequent analgesic use.
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[edit] Classification
Medication overuse headache is a recognized ICDH classification.[1]
[edit] Causes
These types of headaches are known to occur with frequent use of many different medications including most commonly: triptans, ergotamines, analgesics, opioids.[1]
[edit] Treatment
MOH is common and can be treated. The overused medications must be stopped in order for the patient's headaches to resolve. This is usually done under the care of a neurologist. Often patients are started on preventive medications to ease their transition off the medications that induced the medication overuse / rebound cycle. It is important that the patient's physician be consulted before abruptly discontinuing medications as abruptly discontinuing some medications has the potential for creating another issue. Abruptly discontinuing butalbital, for example, can actually induce seizures in some patients, although simple over the counter analgesics can safely be stopped by the patient without medical supervision. A long acting analgesic/anti-inflammatory, such as naproxen (500mg twice a day) can be used to ease headache during the withdrawal period.[2][3] Where a physical dependence or a rebound effect such as rebound headache is possible gradual reduction of medication may be necessary.[4] Two months after completion of withdrawal patients suffering from medication overuse headache typically notice a marked reduction in migraine and other headache frequency and intensity.[5]
[edit] Prevention
In general, any patient who has frequent headaches or migraine attacks should be considered as a potential candidate for preventive medications instead of being encouraged to take more and more painkillers or other rebound-causing medications. Preventive medications are taken on a daily basis. Some patients may require preventive medications for many years; others may require them for only a relatively short period of time such as six months. Effective preventive medications have been found to come from many classes of medications including neuronal stabilizing agents (aka anticonvulsants), antidepressants, antihypertensives, and antihistamines. Some effective preventive medications include Elavil (amitriptyline), Depakote (valproate), Topamax (topiramate), and Inderal (propranolol).
[edit] History
Rebound headache was first described by Dr. Lee Kudrow.[6]
[edit] See also
[edit] References
- ^ a b "216.25.100.131" (PDF). the Headache Classification Subcommittee of the International Headache Society. http://216.25.100.131/ihscommon/guidelines/pdfs/ihc_II_main_no_print.pdf.
- ^ Silberstein, Stephen D. & McCrory, Douglas C. (2001) "Butalbital in the Treatment of Headache: History, Pharmacology, and Efficacy." Headache: The Journal of Head and Face Pain 41 (10), 953-967.
- ^ Loder, Elizabeth & Biondi, David (2003) "Oral Phenobarbital Loading: A Safe and Effective Method of Withdrawing Patients With Headache From Butalbital Compounds." Headache: The Journal of Head and Face Pain43(8), 904-909.
- ^ de Filippis S, Salvatori E, Farinelli I, Coloprisco G, Martelletti P (2007). "Chronic daily headache and medication overuse headache: clinical read-outs and rehabilitation procedures". Clin Ter 158 (4): 343–7. PMID 17953286.
- ^ Zeeberg P, Olesen J, Jensen R (June 2006). "Probable medication-overuse headache: the effect of a 2-month drug-free period". Neurology 66 (12): 1894–8. doi:. PMID 16707727. http://www.neurology.org/cgi/pmidlookup?view=long&pmid=16707727.
- ^ Kudrow L (1982). "Paradoxical effects of frequent analgesic use". Adv Neurol 33: 335–41. PMID 7055014.
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