Medication-overuse headache: painkillers are not always the answer

Paradoxically, liberal use of analgesics to treat primary headache disorders, especially migraine, often results in the development of a daily headache, which itself is indistinguishable from the original headache and frustratingly refractive to analgesia. So-called medication-overuse headache1 (MOH) is common, affecting approximately 1.5–3.0% of the population and is also regarded as a major cause of disability in adults under the age of 50 years.2 This editorial will discuss how to avoid MOH and provide alternative treatment strategies. MOH (also known as rebound-headache) is a secondary headache disorder, defined as: ‘Headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more, or 15 or more days per month, depending on the medication) for more than 3 months.’ 1 MOH has no distinguishable features and therefore mirrors the pre-existing primary headache for which analgesics are being used. MOH typically occurs in patients with a background of primary headache who regularly use analgesics. In approximately two-thirds of patients there is a background of migraine and, in a third, tension-type headache. Medication-overuse headache is rare in patients with cluster headache. Although frequent headaches may be the initial reason for analgesic use, MOH may occur when analgesics are used for …