When Less is More: Preventing and Treating Medication-Overuse Headaches
What are medication overuse headaches?
Medication-overuse headaches (MOH), also known as “Rebound headaches”, is defined as when a person with a pre-existing headache disorder (most commonly migraines) experiences headaches on more than 15 days per month while taking at least one short-term headache medication for at least 3 months.
There are no symptoms specific to MOH since it is diagnosed by frequency and habits of the patient, but some symptoms may include experiencing a headache upon waking up, neck pain, and still feeling tired after sleeping, all of which tend to improve with stopping the overused medication.
What is medication overuse?
Certain medications and drug classes can increase the risk of MOH when used in excess:
- Over-the-counter pain-relieving medications such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin), naproxen (Aleve) when used for 15 or more days per month.
- Combination pain relievers that contain a caffeine, aspirin, and acetaminophen component (Excedrin) when used for 10 or more days per month.
- Triptans and Ergotamines (prescription medicines such as Sumatriptan) when used for 10 or more days per month.
- Opioids (oxycodone, tramadol, morphine, hydrocodone) when used for 10 or more days per month.
- Caffeine intake more than 200 mg per day (a typical cup of coffee has 95 mg caffeine).
How do we treat MOHs?
The best approach to treating MOH is to prevent it in the first place (see next section). However, the most effective method to treat MOH is to stop the medication that is overused.
It is important for the patient to know that when the overused medication is stopped, there may be a period where the headaches get worse. They may also experience symptoms like nausea, vomiting, or insomnia as the medication is stopped. Though, the headaches and symptoms will eventually get better over time.
The patient’s doctor will decide if the overused medication can be stopped rapidly or if it needs to be tapered slowly. It may take anywhere from couple of weeks to a few months to break the headache cycle.
How do we prevent MOHs?
- Educating and counseling patients to limit the use of any short-term migraine medications to an as needed basis or to less than 10 days per month.
- Note – this is different from medications patients take daily to prevent headaches or reduce the frequency of migraine headaches
- Contact your doctor if you need to take headache medications (both over the counter and prescription) more than two days per week.
- Contact your doctor if you have headaches more than four days per month or a headache that lasts more than 12 hours at a time. You may need to be on a headache preventive medication.
- Control and avoid anything that triggers your headaches. Common triggers include dehydration, hunger, lack of sleep, stress, and certain foods and drinks.
- Patient should keep a headache diary to document the frequency, severity, duration of attacks, as well as response to medications, and potential triggers to share with their provider.
Prepared by Josh Paragas, PharmD Candidate 2022
- Tepper SJ, Tepper DE. Breaking the cycle of medication overuse headache. Cleve Clin J Med. Available at: https://pubmed.ncbi.nlm.nih.gov/20360117/
- Wilson MC, Jimenez-Sanders R. Medication Overuse Headache. American Migraine Foundation. Available at: https://americanmigrainefoundation.org/resource-library/medication-overuse/