Managing medication-overuse headache
Q: What is the best treatment for medication-overuse headache?
A: Medication-overuse headache can be caused by prolonged use of any headache medication (e.g. triptans, paracetamol, NSAIDs, combination analgesics).1.2 Medication withdrawal is the only effective treatment.2-4
Consider specialist referral and inpatient withdrawal for people who overuse combinations of medications, or medications containing barbiturates, tranquilisers or opioids, as well as those with anxiety or depressive disorders.3.4
Explain to people that the medication they are taking regularly is the main cause of their headache.3 Ensure that they understand that the outcome of medication withdrawal is usually good (compared with the alternative: ever-increasing headache).3
During withdrawal limited use of naproxen, metoclopramide or nightly low-dose amitriptyline may help to reduce withdrawal symptoms including exacerbation of headache.2 Reduce the risk of relapse through planned follow-up and ongoing support.3
The prevalence of medication-overuse headache is about 1% of adults in the general population.1 People with medication-overuse headache have a history of primary headache (e.g. tension-type, migraine).1 Diagnosis can only be confirmed once the overused medication is stopped and headaches resolve or revert to their original pattern.2
Prevent medication-overuse headache by advising people not to take medications more than 2–3 days per week and encourage use of a headache diary to record headache frequency and medication use.1-3
1. Anonymous. Management of medication-overuse headache. DTB 2010;48:2-6.
2. Neurology Writing Group. Therapeutic Guidelines: Neurology, Version 4 Updated November 2011 [eTG complete CD-ROM]. Melbourne: Therapeutic Guidelines Ltd, 2011.
3. British Association for the Study of Headache. Guidelines for all health professionals in the diagnosis and management of migraine, tension-type headache, cluster headache and medication overuse headache. Hull: BASH, 2010. http://www.bash.org.uk/ (accessed 13 December 2011).
4. Scottish Intercollegiate Guidlines Network. Diagnosis and management of headache in adults. Edinburgh: NHS Quality Improvement Scotland, 2008. http://www.sign.ac.uk/pdf/sign107.pdf (accessed 19 December 2011).
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