Chapter 20 – Too Much of a Good Thing: Medication Overuse Headache

The overuse of analgesic medications is one of the most significant factors that transform episodic migraine to chronic migraine. Classified as “medication overuse headache (MOH),” it is frequently observed in the primary care setting, is one of the most common headaches seen in tertiary care headache clinics, and should be considered in any individual with chronic migraine. Although all acute analgesics may induce migraine progression, they do not share the same propensity or pathway in doing so. Several factors, including headache frequency and genetic and behavioral influences, have been implicated in MOH development. Similarities between MOH and addiction have been reported. Treatment of MOH involves initiation of effective prophylaxis and detoxification for the offending substance(s). Detoxification is sometimes best achieved in an inpatient setting. Effective MOH treatment involves behavioral, pharmacological, and physical modalities. Once the offending medication has been discontinued and effective prevention initiated, it may take several months before the headaches regress to episodic.