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When you have a headache, the first thing you reach for is medication to take away the pain. Pain relief comes in the form of over-the-counter medications such as ibuprofen or acetaminophen (Tylenol), or stronger medication prescribed by your doctor. Either way, it makes sense to take a pain reliever when you’re in pain.
However, there’s such a thing as too much of a good thing. When a headache sufferer uses headache medications too often—especially “acute” medications that aim to relieve an individual headache attack—they may develop a disorder known as medication-overuse headache (MOH).
To unpack this paradoxical condition, Dr. Moises Dominguez, an Assistant Professor of Clinical Neurology, Assistant Attending Neurologist and headache specialist at Weill Cornell Medicine, provides answers to your FAQs, along with the best ways to deal with MOH.
MOH usually affects people who already have an underlying headache disorder, such as migraine or tension-type headache.
A person is said to have MOH if they meet the following criteria:
“Generally,” says Dr. Dominguez, “certain acute or ‘use as needed’ medications have the potential to cause MOH.” These may include:
“The symptoms of MOH can vary widely,” he says. “It depends on the type of underlying headache disorder a person has and the medication or combination of medications being overused. However, the key symptom is experiencing headache on more days per month than not; specifically, at least 15 days per month.”
MOH can present with frequent headaches that have a migraine presentation: a throbbing headache of moderate-to-severe intensity, often associated with nausea, vomiting, and sensitivity to light and noise.
Diagnosing MOH begins with a detailed medical history and a thorough neurological examination, Dr. Dominguez says. “The clinician will look for specific signs in the patient’s headache history that might require additional tests, including blood tests and brain imaging.
“Patients are also encouraged to keep a headache diary,” he continues. “The diary is crucial for diagnosing MOH, as it helps track how often headaches occur, the associated symptoms, the medications used and how often.”
If a person meets the diagnostic criteria for MOH (mentioned earlier), they are diagnosed with MOH.
The first step in treating MOH is to educate the patient on what the disorder is and why it occurs, he explains.
“It's important to understand that medication overuse is not the patient’s fault. It simply means that the treatment plan needs to be optimized,” says Dr. Dominguez.
Treatment includes prescribing effective preventive medications to reduce the overall burden of headaches, meaning their frequency and severity, as well as any disability they cause. Additionally, patients are advised to discontinue or limit the use of the overused medication. In cases where that is challenging, bridge therapy, such as steroids or long-acting NSAIDs, may be considered as a way to help patients discontinue the overused medication.
Regular follow-up visits with a specialist are important to ensure that the patient’s headaches are well-controlled, he advises.
Make an appointment with a Weill Cornell Medicine headache specialist by visiting the Headache Program’s website or calling (212) 746-2596.