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:
Follow a course
- Learn from wherever, whenever, and at your own pace
- Interactive online courses from an award-winning team
- CEU/CPD accreditation in the Netherlands, Belgium, US & UK
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
Follow a course
- Learn from wherever, whenever, and at your own pace
- Interactive online courses from an award-winning team
- CEU/CPD accreditation in the Netherlands, Belgium, US & UK
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
Follow a course
- Learn from wherever, whenever, and at your own pace
- Interactive online courses from an award-winning team
- CEU/CPD accreditation in the Netherlands, Belgium, US & UK
Finally Learn how to Diagnose & Treat Patients with Headaches
What customers have to say about this online course
- Robbert Alblas13/09/24Headache Treatment in Clinical Practice Great insights
Very useful evidence based information. I do think this would be better if he would talk in his own language.Barry de Wit17/08/24Headache Treatment in Clinical Practice Review Headache Treatment in Clinical Practice
De cursus is erg duidelijk. Ook zijn de instructievideos wat betreft de tests en behandelingen erg nuttig om in de praktijk toe te passen! - Broes de Landsheer10/05/24Headache Treatment in Clinical Practice REVIEW COURSE HEADACHE
Iets te wetenschappelijk. Er worden heel veel artikels gegeven die je moet lezen en zo kom je aan het aantal uren studietijd. De video’s zijn echter zeer beknopt. Er worden ook geen slides gegeven van de video’s (je hebt dus geen naslagwerk).
Weinig praktisch toepasbaar vond ik.
Comment Physiotutors: Wij hebben inmiddels alle slides toegevoegdGoswin Arts-Opdam10/05/24Headache Treatment in Clinical Practice HEADACHE TREATMENT IN CLINICAL PRACTICE
Erg fijne en duidelijke cursus. Je krijgt genoeg handvatten mee en daarna kan je zelf bepalen welke je toepast in de praktijk. Ik kan patiënten met verschillende hoofdpijn nu in elk geval beter helpen. - Beppeke Molenaar14/04/24Headache Treatment in Clinical Practice OVERALL A GREAT COURSE
Great course, very informative.Tessa van der Zanden26/03/24Headache Treatment in Clinical Practice GOED TOEPASBARE CURSUS
Cursus die gelijk goed toepasbaar is in de praktijk. De Nederlandse ondertiteling is erg fijn. Goede balans tussen theorie en praktijk. Makkelijk in eigen tijd in te plannen en uit te voeren. - Bart de Ruijter20/03/24Headache Treatment in Clinical Practice LEUKE TOEPASSELIJKE CURSUS
Leuke toepasselijke cursus, nu ook vertaald in het Nederlands, wat het makkelijker maakt.
Filmpjes zijn wel in Engels, maar ondertiteling aan is een optie.
Goede combinatie van theorie, wetenschap en praktische handvaten.
Zeker een aanrader.Peter Tuyp27/02/24Headache Treatment in Clinical Practice GOOD COURSE
Good course, easy to follow.
Knowledge up to date after course. - Harmen van Delft25/02/24Headache Treatment in Clinical Practice INSTRUCTIEVE HOOFDPIJN CURSUS
de theoretische achtergrond en praktische vaardigheden zijn goed gecombineerd en bruikbaar in de praktijk.Laura Bradshaw05/02/24Headache Treatment in Clinical Practice GREAT CONTENT AND RESOURSES
The course was full of explanations, plenty of research and demonstrations. I would say that it took me longer than 14 hours to complete as I wanted to be thorough with my reading and practical component.
Rene and the physio tutors team were always available via email if you needed any info.
I would recommend this course if you want a better understanding of the management and manual therapy of headache and migraine. - Jelter Wahlen03/12/23Headache Treatment in Clinical Practice GREAT COURSE!
Great course to update your knowledge about headaches.
Evidence based and easy to implement in practice!Max Dienemann09/10/23Headache Treatment in Clinical Practice TOP
Great course! Everything is covered from diagnosis to treatment (-options) including the latest evidence backing everything up. The practical/skills videos on are also perfectly explained, therefore hands on skills and exercises can be easily implemented in daily practice. - 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 knowledge - M.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.