Medication-Overuse Headache (MOH)
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.
Who may be vulnerable to medication overuse headache (MOH)?
MOH usually affects people who already have an underlying headache disorder, such as migraine or tension-type headache.
What are the diagnostic criteria for MOH?
A person is said to have MOH if they meet the following criteria:
- They have headaches on 15 or more days per month and already have an underlying headache disorder.
- They regularly overuse medications to treat each headache attack.
- They have been overusing medications for more than 3 months.
- Their frequent headaches are not due to another underlying cause.
What is considered “overuse”?
“Generally,” says Dr. Dominguez, “certain acute or ‘use as needed’ medications have the potential to cause MOH.” These may include:
- Simple analgesics, such as acetaminophen, ibuprofen, naproxen or aspirin: Using these on 15 or more days per month for more than 3 months can lead to MOH.
- Combined pain relievers, such as acetaminophen-aspirin-caffeine and butalbital-acetaminophen-caffeine: Using these on 10 or more days per month for more than 3 months can lead to MOH.
- Triptans, such as sumatriptan and rizatriptan, and ergotamines, such as dihydroergotamine: Using these on 10 or more days per month for more than 3 months can lead to MOH.
- Opioids, such as tramadol, codeine and and oxycodone: Using these on 10 or more days per month for more than 3 months can lead to MOH.
What are the symptoms of MOH?
“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.”
Are the symptoms comparable to migraine?
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.
How do you diagnose MOH?
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.
How is MOH treated?
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.
Summary
- Medication overuse headache (MOH) generally affects people who already have a headache disorder.
- If a patient has headaches on 15 or more days a month, regularly overuses medication and has been doing so for more than 3 months, and no other cause of frequent headaches is found, they may have MOH.
- Both OTC and certain prescription medications can be overused.
- Specialists treat MOH by educating their patients about the condition, advising them to discontinue or limit the overused medication and prescribing effective preventive medication.
- “Overuse” is not the patient’s fault. It’s normal to seek pain relief when dealing with pain. A headache specialist can help you downsize your use of the problematic medication and prescribe a preventive medication to reduce the frequency and severity of your headaches.
Make an appointment with a Weill Cornell Medicine headache specialist by visiting the Headache Program’s website or calling (212) 746-2596.