Med-overuse HA

Question 1

What is MOH?

What medications may cause MOH?

Answer 1

Secondary headache disorder, may occur with overuse of acute migraine medications (triptans, ergotamines, ditans) / non-migraine medications (analgesics, NSAIDs)

MOH common with narcotics such as opioids, barbiturates => not recommended for migraine treatment due to MOH + addiction and abuse potential)

Question 2

Can MOH be reverted to episodic headache?

Answer 2

Yes, with drug withdrawal

Question 3

What are 3 ways to avoid MOH?

Answer 3

• Acute treatment is recommended to be limited to an average of 2 HA days per week, and within <10 days per month
• Preventive treatment of migraine should be considered for pt exceeding this acute tx limit
• Acute tx should NOT be used in anticipation of migraine attacks

Question 4

MOH diagnosis

Answer 4

Fulfill all 3 criterias:

1. HA occuring on >=15 days per month (for more than 3 months) in a pt with preexisting HA disorder
2. Regular overuse of acute and/or symptomatic HA drugs for >3months of:

• > =10 days per month for ergots, triptans, opioids, combi analgesics
• > =15 days per month for simple analgesics (paracetamol/acetaminophen/aspirin/NSAIDs)
• > =10 days per month for any combi of the above-mentioned drugs, or one or more meds other than those mentioned above, taken for acute or symptomatic tx of HA

3. HA cannot be better accounted for by another ICHD-3 diagnosis

Question 5

Describe the vicious cycle of med overuse headache

Answer 5

• Short term pain relief
• Rebound HA
• Higher medication dose