Studies indicate that up to 45% of patients can relapse to MOH, even after initial improvement and back-transformation from chronic to episodic pain is achieved. Predictors of relapse include the type of primary headache and the type of drug overused. Patients suffering from more than one type of headache relapse more often and tension-type headaches sufferers are more likely to relapse than migraineurs. Combination medications, especially those containing barbiturates and tranquillizers, are more commonly associated with relapse than single-drug and non-narcotic remedies. As mentioned above, relapse to MOH may have been unintentionally precipitated during trial titration of preventative drugs. This should be determined if possible, so that adequate levels of prophylaxis can be resumed, in addition to re-withdrawal of the drug causing the rebound. We note that age, sex, length of headache history and previous intake of preventative drugs are not predictive of relapse. It should lastly be highlighted that MOH can occur or reoccur if patients have been prescribed precipitating drugs by another doctor for a separate condition. Therefore questions about overall patient health changes should always be included when taking a patient’s history of headaches, whether or not MOH is suspected.
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.