Ergotamine, triptans, and the global challenge of medication-overuse headache: a call to action from Asia–Oceania

At the same time, there is a largely unrecognised dimension of MOH in LMICs: the unreported harm from excessive use of paracetamol, ibuprofen, and other simple analgesics.These drugs are inexpensive, widely available without prescription, and often used daily for headache relief in communities with limited access to specialist care.Chronic overuse not only fuels MOH prevalence but also contributes to additional complications such as gastrointestinal bleeding, renal impairment, and liver injury.In many parts of Asia-Oceania, the burden of MOH arising from analgesic overuse may be enormous but invisible, rarely captured in registries or national statistics.The Asia-Oceania region shows this paradox clearly.It is home to nearly half the world's population.Countries like Japan, Singapore, and Australia have advanced neurological services.In these places, ergotamine use is rare, though it still appears from time to time.Australia has also successfully eliminated overthe-counter codeine-containing medications.By contrast, fragile systems in South and Southeast Asia still face widespread ergotamine and analgesic overuse.Clinicians in Sri Lanka, Indonesia, the Philippines, and India continue to see entrenched ergotamine dependence.They also report high rates of self-medication with over-the-counter painkillers.The Asian Regional Consortium on Headache (ARCH) has repeatedly highlighted this as a major regional priority.Taken together, these patterns show that MOH is not simply a pharmacological problem but a systemic one,