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Medication overuse headache (previously known as rebound headache) is a relatively frequent problem we encounter in clinical practice. We believe that medication overuse headache, as well as acute medication overuse, are significantly underdiagnosed. From our experience, over 70% of all new patients that we see in headache practice exhibit patterns of acute medication overuse. It is critical to recognize acute medication overuse as it may directly impact the way we would approach the headache treatment.
Medication overuse headache is a complication of a pre-existing primary headache disorder (most frequently migraine). It occurs in those patients with pre-existing migraine who, for whatever reason start overusing acute or abortive medications. Acute medication overuse gradually leads to headaches becoming more frequent and less responsive to acute therapy.
Patients typically have a history of migraine that has been gradually progressing and getting worse and more frequent while patients have been using their rescue medications in increasing frequency. It typically takes several months for the medication overuse headache to develop. Eventually, patients start noticing headaches are becoming not only more frequent but also less controlled with their usual rescue medications.
Medication overuse headache diagnosis is clinical and can be challenging. A thorough analysis of medication use patterns is crucial.
One of the most important steps in medication overuse headache management is the discontinuation of the medication that is contributing to the development of MOH. Some medications can be stopped abruptly while others will require very slow tapering. Stopping certain medications can be challenging as headache symptoms frequently may get worse before they would get better. It is important to develop a treatment strategy that would help manage patient’s symptoms during this process.