Medication Overuse Headaches (MOH)

A large percentage, perhaps a majority, of daily headaches may be due to medication overuse – so-called “rebound headaches.” This phenomenon was first described in 1982 by Dr. Lee Kudrow, father of popular actress Lisa Kudrow, who has suffered from cluster headaches herself. We note that medication overuse headaches and chronic headaches often have a complex and uncertain cause-and-effect relationship with each other, best summarized non-technically as the chicken-and-egg problem! However those already having a headache condition are more likely to slip into MOH than those without existing regular headaches. In this case the headache is said to have “transformed” from episodic to chronic. Population-based studies suggest that at least 2% of all headaches are from medication rebound. Risk factors for MOH beyond a pre-existing headache condition are unknown, but psychological and behavioral factors such as pain threshold and predisposition to addiction are likely to also be involved.

Because of the severity of migraine and cluster headache attacks, there can be understandable anxiety in patients in anticipation of the next one. This can lead to taking of medication at the mere possibility of a headache, for example before a stressful situation. Behaviorally, the threshold for the patient taking medication is often lowered. While no single extra dose of medication is harmful in itself, a pattern of daily medicating can arise. Often at this point, when the medication is skipped, there is a withdrawal headache – not necessarily a migraine or cluster attack, but the sufferer is again apt to take the medication.

Thus a series of “rebound” headaches can occur, each reinforcing the taking of medication. A person naturally views  medication as a response to pain, so it is understandably counterintuitive that pain could be a response to the medicine – but in this case it is, if only upon its withdrawal. Patients are susceptible to overmedicating themselves with both OTC and prescription drugs, regardless of whether or not they contain ingredients liable to cause addiction per se, such as a narcotic. However, medications containing opioids and narcotics have an even greater likelihood of leading to MOH than those not containing these compounds. Narcotic pain relievers appear to require fewer doses per week or month than OTC products to bring about the transformation from episodic to chronic. https://houstonheadache.com/medication-overuse-headaches-moh/Thus, patients with frequent headaches should be advised to strenuously avoid triggers, practice variation in their responses to the beginnings of headache symptoms, and aim to take no medication more than two or three times per week, including triptans. Such patients are also excellent candidates for preventative therapy.

If you are suffering from one or more of these conditions, and you would like us to help, please call our office today at 713.467.4082.