HA- Medication Overuse HA Flashcards
How does medication overuse HA occur? (the patho)
Increased excitability of neurons in the cerebral cortex and trigeminal system –> facilitates cortical spreading depression and peripheral and central sensitization
Diagnostic criteria for medication overuse HA
Headache occurring on ≥15 days/month in a patient with a pre-existing headache disorder
Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of HA
Not better accounting for by another ICHD-3 diagnosis
How often do anti-migraine ergots need to be used per month to trigger a medication overuse HA?
≥10 days
How often do triptans need to be used per month to trigger a medication overuse HA?
≥10 days
How often do opioids need to be used per month to trigger a medication overuse HA?
≥10 days
How often do non-opioid analgesics need to be used per month to trigger a medication overuse HA?
≥15 days
How often does butabital need to be used per month to trigger a medication overuse HA?
≥5 days
Medication overuse HA treatment
D/C or wean off the overused medication
Can consider bridge therapy during the initial period after D/C
Initiate preventive with PRN breakthrough therapy
