Medication overuse headache

If medication for treatment of headaches is used too often a so called medication overuse headache (MOH) can occur. According to insurance company records, about 160,000 people get treated in-patient for MOH each year. About 1 to 2% of the population in Germany is affected by this problem – about 800,000 to 1.6 million people.

It is a constant diffused and throbbing headache without the typical accompanying symptoms of migraine. The overuse of pain and migraine medication can also cause an increase in the frequency of attacks of migraine, an increase in duration, an increase in intensity and a decreased reaction to the medication. The suspicion that treatment of headaches cause headaches should always arise if:

– Headache medication is taken on more than 10 days a month for over 3 months

– Headaches occur on more than 15 days a month and a decrease in headaches occur within 2 months after stop of medication.

Medication stop in the clinic

If a MOH exists, a so called medication stop is performed, also called “drug-holiday”. During the first phase of the treatment the patient will be informed extensively about the mechanisms of the development of headaches and the effect of the continuous use of medication. On top of that the patient will also be extensively informed about the further treatment during the medication stop.

A medication stop usually has to be done in-patient. Since so called rebound or adjustment headaches occur during the break, these would usually result in taking medication again at home. In specialized clinics, such as the Schmerzklinik Kiel, the continuous use of headache medication is aborted abruptly. To reduce the then occurring adjustment headaches the patient will receive medication which increases the deployed messenger substances. Usually, a two week long treatment with infusions is performed. The treatment is accompanied by an intensive behavioral medical program in which the patient learns concepts for non-medicamentous prophylaxis. Of course, the patient will also learn the appropriate use of headache medication so that each one is capable of using the medication properly and in the right dose afterwards. The emphasis is on the right behavioral medical prophylaxis of the headache without medication though.

Don’t let it come that far

If you respect the following critical rules you can almost completely prevent MOH:

Rule 1: Appropriate behavior for taking medication

Don’t use headache pain medication on more than 10 days a month.

Rule 2: Frequency of headaches

Don’t medicate yourself if you have headaches on more than 10 days a month. See a doctor!

Rule 3: Preparation and type of analgesics

Don’t use medication with two or more substances (and no opiodanalgetics for migraine or tension headaches). The mixing of the actual active substance of the pain medication (with for example codeine, caffeine, ethenzamide, thiamine, chinin, salacetamineand others) doesn’t increase the effect of the medication but the accompanying risk and danger of psychical accustoming so that an increase of the dose and thus the uninterrupted headache becomes highly likely. Patients who have been treated in the Schmerzklinik Kiel for this problem have shown that he pain medication withdrawal takes longer and is more difficult the more substances a medication has or the more different active substances are mixed in simultaneously taken medication.