Via practica 7-8/2009

Drug induced headache (Medication overuse headache)

Medication overuse headache is considered to be the result of an interaction between an exposure (overuse of analgesics, triptans) and a biologically vulnerable individual (migraineur). In migraineurs, but not in individuals without migraine, medication overuse is a risk factor for chronic daily headaches. Additionally, psychiatric comorbidity (e.g. anxiety disorders and/or depression) represents a relevant risk factor. Therefore, medication overuse headache (transformed migraine) should be prevented. Potential strategies include limiting the use of acute medications to no more than 10 days per month and reducing headache frequency in migraineurs with preventive medication and nonpharmacological strategies, such as proper diet, weight loss, exercise, cognitive behavioral therapy, and education. In Europe and USA, 30 % – 80 % of the patients seen in a headache clinic have medication overuse headache. In individuals with established medication overuse headache treatment requires detoxification, „bridge therapy“ during detoxification, pharmacological and nonpharmacological preventive strategies, and education.

Keywords: overuse of analgetics, triptans, migraine, medication overuse headache, detoxification, preventive strategies