Headache, Medication-Overuse (MOH)

Notes
  • This type of headache is caused by chronic and excessive use of medication to treat headache
  • It is also known as rebound headache
  • It is quite intense and persistent and many times it is worst on awakening
  • It is the most common secondary headache disorder affecting up to 5% of global populations, women more than men.
Symptoms
  • Intense and persistent headache
  • At its worst it can cause the patient to wake up at night because of pain
Diagnosis
  • Clinical evaluation
Differential
  • Migraine headache
  • Tension headache
  • Cluster headache
Prevention
  • Amitriptyline
  • Metoprolol
  • Propranolol
  • Sodium valproate
  • Topiramate
Management
  • Withdrawal of overused medications (beware of withdrawal symptoms and worsening of headache) – this can be done gradually
  • A long-acting analgesic/NSAIDS can be used to ease headache during the withdrawal period
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