Breaking the cycle of medication overuse headache
In the April 2010 edition of the
Cleveland Clinic Journal of Medicine is a clinical review titled
Breaking the cycle of medication overuse headache by Stewart J Tepper and Deborah E Tepper that begins:
" When patients who have frequent, disabling
migraines take medications to relieve their symptoms, they run
the risk that the attacks will increase in frequency to daily or
near-daily as a rebound effect comes into play. This pattern,
called medication overuse headache, is more likely to happen
with butalbital and opioids than with migraine-specific drugs, as
partial responses lead to recurrence, repeat dosing, and,
eventually, overuse. Breaking the cycle involves weaning the
patient from the overused medications, setting up a preventive
regimen, and setting strict limits on the use of medications to
relieve acute symptoms.
" The authors make the following key points:
Medication overuse headache can occur with as few as 5 days per month of treatment with butalbital or 8 days per month with opioids.
The features vary, but the most important is headache on 15 or more days per month, lasting at least 4 hours if untreated, for at least 3 consecutive months. Other common symptoms are morning headaches, neck pain, nonrestorative sleep, and vasomotor instability, all of which tend to improve with weaning from the overused medications.
Daily preventive treatment is indicated when patients have 10 or more headaches per month or severe disability from their attacks.
With treatment, the prognosis for medication overuse headache is good. However, patients need close follow up to prevent recidivism. "
For the full review, click here.
Cleveland Clinic Journal of Medicine 77(4):236-242 © 2010 The Cleveland Clinic Foundation
Breaking the cycle of medication overuse headache. Stewart J Tepper and Deborah E Tepper. Correspondence to: Stewart Tepper
teppers@ccf.org Category: N. Neurological. Keywords: medication, overuse, headache, clinical review.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia Posted on Global Family Doctor 13 July 2010
