Medication Overuse Headache | Headache & Dizziness Assessment

Headaches can manifest on their own but are also a very 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 is suffering from. 

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 overdose, or neck pain aka the Cervicogenic headache.

Now let’s take a closer look at medication overuse headache, which is a secondary type headache.
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.

In order for a headache to be attributed to medication overuse it has to fulfill certain criteria: 

1. The headache occurs on ≥15 days/month in a patient with a pre-existing headache disorder
2. Regular overuse for more than 3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headaches. 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
3. Not better accounted for by another headache disorder

As a side note, you should also pay attention to excessive consumption of substances such as caffeine as they can evoke similar headache symptoms.

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Tools you can use to assess the impact of a headache on your patient are the HIT-6 questionnaire which you can find in the video description. Also note that it can be difficult for a patient to answer all of the questions on duration, intensity, and characteristics of their headache during your assessment. Therefore asking them to complete a headache diary can help in the assessment and management of the headache and you should be aware that there can be overlap between multiple headache disorders.

If you would like to learn how to diagnose other common forms of headaches, check out the posts below:

• Tension-type headache
• Cervicogenic Headache
• Migraine
• Cluster Headache

The Watson Test is a common provocation test used in the assessment of tension-type headaches and migraines.

References:

Kristoffersen, E. S., & Lundqvist, C. (2014). Medication-overuse headache: epidemiology, diagnosis and treatment. Therapeutic advances in drug safety, 5(2), 87-99.

Kristoffersen, E. S., & Lundqvist, C. (2014). Medication-overuse headache: epidemiology, diagnosis and treatment. Therapeutic advances in drug safety, 5(2), 87-99.