Medication Overuse Headache
Migraine
MOH is a chronic secondary headache which evolves because of frequent use of over the counter and prescription medication.
If you are taking medication on more than 6 days per month you should consult your GP. It affects as much as 5% of the population. (WHO 2023)
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Who is at risk?
People who live with migraine and/or other headache disorders such as migraine or tension type headache, are at risk of developing medication overuse headache.
Some may not realise they live with migraine, so it is important to speak to your GP if you have any concerns about MOH.
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What To Do?
Speak with your GP and Pharmacist if you are concerned that you are at risk of developing Medication Overuse Headache.
Your GP will assess you and support you in preventing/treating Medication Overuse Headache.
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The Symptoms
Below are the most common symptoms associated with Medication Overuse Headache:
- Worsening of frequency and/or severity of primary headache attacks (such as migraine attacks) over months/years.
- Progressively increased use of acute medications (taken from IHS).
- Frequent headache with frequent use of painkillers.
- Preventative medication becomes less effective.
- The headache is often at its worst in the morning and becomes more severe after physical activity.
- Headache temporarily worsens if medication is stopped/wears off.
- Other conditions such as depression or sleep disorders may also be present.
- There may be nausea, forgetfulness, and/or restlessness.
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Treatment
The treatment is the withdrawal of the acute medication that is being taken and to manage the underlying migraine attacks differently with your doctor.
Evidence based treatment of Medication Overuse Headache consists of three elements:1) Withdrawal of the overused and inefficient acute medication
2) Adding an efficient preventive treatment strategy if needed including:
non-drug strategies such as getting regular exercise, regular sleep, taking steps to address stress, eating a regular balanced diet, and drinking enough water (see links below for more detailed information on non-drug strategies).
Daily oral headache preventative medications.
Injectable headache preventative medications.3) Close follow-up and use of headache calendar/diary.
The treatment plan depends on the patient. Some patients may have other health conditions that may make withdrawal more difficult. Withdrawal symptoms can include, temporary worsening headache, poor sleep, restlessness, nausea, or stomach upset. You should always discuss a withdrawal plan with your doctor before the withdrawal of painkillers.
(Migraine Trust 2023)
(International Headache Society 2023) -
You can learn about headache prevention strategies, including drug and
non-drug related here:What is the SEEDS method for migraine control? – Migraine World Summit
‘SEEDS’ for success in migraine management – Mayo Clinic News Network
Migraine attack triggers – The Migraine Trust
Preventive medicines – The Migraine Trust
Medication-Overuse Headache Awareness Campaign – International Headache Society (ihs-headache.org) -
How can Medication Overuse Headache be avoided?
To decrease the risk of developing MOH a person can make a headache management plan, to manage their primary headache condition (such as migraine, cluster headache, tension type headache) with their doctor. In addition to this, they can also take steps to manage their lifestyle and manage their triggers, with the support of their doctor.