Medication Overuse Headache | Diagnosis & Treatment

Medication Overuse Headache | Diagnosis & Treatment
Introduction & Epidemiology
Headaches can manifest on their own but are also a common symptom in neck pain patients as more than 60% of patients with a primary neck pain complaint report having concordant episodes of neck pain. Therefore, it’s essential to find out what kind of headache the patient suffers.
To start off let’s differentiate between primary and secondary types of headaches. But what does this mean? Simply put, primary headaches are a “disease themselves” whereas, in secondary headaches, the headache is a symptom of another condition. So primary headaches would be migraines, tension-type headaches & cluster headaches. Secondary-type headaches are headaches caused by tumors, hemorrhage, other trauma, TMJ dysfunction, substance overuse, or neck pain aka the Cervicogenic headache.
Now let’s take a closer look at medication overuse headaches, which are a secondary type headache.
Epidemiology
The prevalence of medication overuse headaches is reported to be 1-2% in the general population. Women are 3 to 4 times more often affected than men and the prevalence is highest at around 40 years of age.
The following figure shows the prevalence of headaches on different continents around the world:
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Clinical Picture & Examination
In order for a headache to qualify as a medication overuse headache it has to fulfill certain criteria (ICHD-III):
A. The headache occurs on ≥15 days/month in a patient with a pre-existing headache disorder
B. Regular overuse for more than 3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache. For simple analgesics such as paracetamol or NSAIDs, the intake has to be on 15 days or more per month. In the case of triptans and similar medication, 10 days or more per month is enough to diagnose medication overuse headache
C. Not better accounted for by another headache disorderAs a side note, you should also pay attention to excessive consumption of substances such as caffeine as they can evoke similar headache symptoms.
100% Free Headache Home Exercise Program
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Treatment
There is no accepted standard of care for the treatment of medication overuse headaches, and there is insufficient data from appropriately powered randomized clinical trials (RCTs) for us to suggest a particular course of action (de Goffau et al. 2017). The generalizability of these results is doubtful due to the selection of patients with high motivation, exclusion of patients with prior detoxification failures and comorbid psychiatric illnesses, high dropout rates, and uncontrolled trials without intention-to-treat analyses. Tertiary care centers frequently report high rates of treatment success. Individuals with medication overuse headaches range from those who have migraine without comorbidities and are abusing just one medicine to those who have a variety of headaches, significant comorbidity, behavioral dependence, and excessive drug use.
Studies also demonstrate that these disparities are partially culturally conditioned and that medications are misused when they are readily available and reasonably priced (Find et al. 2015).
The general recommendation of management is (de Goffau et al. 2017):
- Make a correct diagnosis based on criteria and the exclusion of other headaches
- Patient Education
- Abrupt withdrawal of overused medication with or without rescue medicine
- Evaluation of who should receive prophylaxis prior to, at onset of, or after drug withdrawal
- Follow-up to avoid relapses & advice about follow-up treatments
Both the prevention and treatment of medication overuse headache are possible, but they are not always simple tasks. The majority of patients should likely be given the option of outpatient withdrawal, although complex situations may necessitate inpatient care. The results of a recent trial with a consensus protocol (Tassorelli et al. 2014)—which included advice on medication withdrawal, early discontinuation with supportive treatment for withdrawal headache, optional early preventive medication, symptomatic treatment using a different medication than the one previously overused, and follow-up over a 6-month period—support the existing recommendations that the majority of patients will benefit from a stepwise combination of advice, withdrawal of overused medications, and monitoring over time.
Want to learn more about headaches? Then check out our following blogs & research reviews:
- Physical Tests for Headaches: Useful?
- The Efficacy of Aerobic Exercise vs. Strength Training in the Treatment of Migraine
- Podcast Episode 031: Headaches with René Castien
References
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Finally Learn how to Diagnose & Treat Patients with Headaches
What customers have to say about this online course
- Danitsja Wendt11/09/23Headache Treatment in Clinical Practice UITGEBREIDE HOOFDPIJNCURSUS
Veel informatie over de drie meest voorkomende hoofdpijnsoorten. Eerst uitgebreid theoretische achtergrond.
Daarna ook veel aandacht voor onderzoeken en behandelingen, verduidelijkt met filmpjes.
Fijn dat deze informatie ten alle tijden teruggekeken kan worden voor een opfrisser.
De cursus zelf is vertaald in het Nederlands, maar de vele wetenschappelijke artikelen zijn dat helaas niet.
Hierdoor ging bij mij wel erg veel tijd zitten in het doornemen daarvan.
Comment Physiotutors: All scientific literature is in English. That is a reality that we cannot change.Willem Nijssen31/07/23Headache Treatment in Clinical Practice GOOD QUALITY COURSE WITH UP-TO-DATE LITERATURE
The course is well structured and with up-to-date literature. It provides enough practical tips. There’s definitely a lot to learn about this subject!Jesse de Louw11/07/23Headache Treatment in Clinical Practice GOOD COURSE
Good EBP study, with a nice variety of information. Sometimes a little bit hard to follow the information given in another language than my own. (Comment Physiotutors: This customer probably did not see the option to switch to Dutch) - Hamad Alkahtani16/06/23Headache Treatment in Clinical Practice Very Interesting info and practical knowledgeM.A.G. Kuipers15/06/23Headache Treatment in Clinical Practice INFORMATIEVE CURSUS MBT HOOFDPIJN
Goede cursus, helaas niet in Nederlands en helaas zijn ook niet alle artikelen makkelijk te verkrijgen
duidelijke filmpjes met goede technieken mbt onderzoek en behandeling
Opmerking Physiotutors: De gehele cursus is wel in het Nederlands verkrijgbaar.Lennart Kroes17/04/23Headache Treatment in Clinical Practice A PERFECT COURSE TO UPDATE YOUR KNOWLEDGE ABOUT HEADACHE
Evidence-based, easy to follow. Perfect! - Erik Swarts09/03/23Headache Treatment in Clinical Practice GREAT COURSE!
First time doing a Physiotutors course. great way to learn on a high level of evidence. You can watch and rewatch everything for as long as you want before you take the exam.Daniel Klimsa31/01/23Headache Treatment in Clinical Practice GREAT COURSE!
Well-structured course with lots of evidence-based material.
Theory is well explained and you get a lot of additional reading material.
I would like to see improved quality of the explanations in the video portion of the course.Barbara Fasol18/01/23Headache Treatment in Clinical Practice A LOT OF INFORMATION!
a lot of good informations, articles.
A really good help to improve your comprehension and your practice
The only downside on this course was for some videos in the practice section, the sound wasn’t working (Comment from Physiotutors: This is intended like this). However, the videos were fairly straight forward without the sound so it was fine to understand the content, so it wasn’t much of an issue to have no sound.
For some section, it didn’t include the latest research but it’s difficult to constantly update the content of a course when new research is published everyday.
One very good point was the fact that the teacher critics some of the studies that were published so you feel that it’s not just reading the conclusion. - Alice Dehout28/12/22Headache Treatment in Clinical Practice GOOD INSIGHT ON HEADACHE TREATMENT
First time doing a course with physiotutors.
I would say the content is very useful, interesting and up to date.
The only downside on this course was for some videos in the practice section, the sound wasn’t working (Comment from Physiotutors: This is intended like this). However, the videos were fairly straight forward without the sound so it was fine to understand the content, so it wasn’t much of an issue to have no sound.
For some section, it didn’t include the latest research but it’s difficult to constantly update the content of a course when new research is published everyday.
One very good point was the fact that the teacher critics some of the studies that were published so you feel that it’s not just reading the conclusion.Mathias28/11/22Headache Treatment in Clinical Practice QUALITY GUARANTEED
First time using Physiotutors; a very user friendly way of learning. An in depth theoretic background to start off with, before continuing to a more practical approach. After every chapter, you’re invited to do a little quiz and thus test yourself. Highly applicable course for your practice.Anthony02/09/22GREAT LEARNING EXPERIENCE INFORMATIEVE CURSUS
First time doing a full online formation on a subject and it was amazing, great way to move through the different topics.
The assessment and quizz keeps you accountable and you have a great, practical tool that you can apply directly into your practice like next day in.
Highly recommended - Ingeborg Dols-de Jonge16/02/22Headache Treatment in Clinical Practice INFORMATIEVE CURSUS
Leuke en interessante hoofdpijn cursus waarbij gebruik gemaakt wordt van up to date wetenschappelijke onderzoeken. Er wordt een mooie afwisseling gemaakt tussen theorie en praktijk. Na deze cursus kun je goed onderscheid maken tussen verschillende soorten hoofdpijn en weet je wat de beste behandelmethode is.Svein Inge31/01/22Headache Treatment in Clinical Practice QUALITY COURSE
I highly recommend this course. You will get many tips of articles who are relevant for diagnostic and treatment of the most common headaches and migraine. Castien is also a great teacher, and explain the stuff in a good way. He has also informative videos.Azad Khan04/01/22Headache Treatment in Clinical Practice AN EXPERTS GUIDE THROUGH THE HEADACHE LANDSCAPE!
No better tutor than René Castien to introduce us to the fascinating field of the treatment rationale and possibilities for physio- and manual therapists. Uptodate, for so far as possible in this fast moving field, practical and with a good deal of treatment options that are both evidence based and with a good deal of clinical expertise. I thoroughly enjoyed the course and was pleasantly surprised by the clear and methodogical presentation of the material. I can highly recommend this course to any clinician engaged with or interested in the treatment of patients with headache. A no nonsense, applicable and practical course! - Elisabetta12/12/21Headache Treatment in Clinical Practice DETAILED AND VERY INFORMATIVE
This course is ideal to expand one’s knowledge on headaches and how to effectively treat them.
The instructor is extremely knowledgeable and provides very practical information, easily applicable in the clinic.
I would highly recommend taking this course to anyone interested in becoming an expert at treating headaches.Dylan08/12/21Headache Treatment in Clinical Practice GREAT COURSE
Good didactic qualities of the teacher with clearly noticeable theoretical knowledge