Medication overuse headaches : Causes-Symptoms-Diagnosis-Treatment

 What are Medication overuse headaches (MOH)?

Medication overuse headaches area unit a regeneration of getting headaches, taking a lot of and a lot of pain medications to alleviate them, that really causes daily to close daily headaches. Breaking the cycle involves stopping your acute medicine, taking preventive medications then victimizing acute medicine with limits.

Medication overuse headache (MOH), could be a headache that results from the frequent use of acute medicines or painkillers, like triptans, ergotamines, opiates, non steroidal medicine medicine (NSAIDs) and paracetamol.

What are Medication overuse headaches (MOH)?
Medication overuse headaches

It develops in individuals with a primary headache disorder, like headache (or a case history of migraine), typically with headache on fifteen or a lot of days per month. The medication itself causes a lot of headaches, that area unit typically brought up as ‘rebound headaches’.

Medication overuse headache is strictly as its name implies – a headache that results from taking analgesic (pain) medication too typically to alleviate your headache. The results of overusing headache medication could be a daily or close to daily headache that the present medications you're taking diminish and are less effective.

Medication overuse headache is additionally referred to as analgesic rebound headache, medication misuse headache or drug-induced headache.

  1. Nervous system

Medical terms

  • Medication overuse headaches or rebound headaches are caused by regular, long use of medication to treat headaches, like migraines. Pain relievers supply relief for infrequent headaches. however if you're taking them quite one or two days per week, they'll trigger medication overuse headaches.

  • If you've got a headache disorder, any medication you're taking for pain relief will cause rebound headaches. Pain relievers taken often for an additional condition, like inflammatory disease, haven't been shown to cause medication overuse headaches in those who ne'er had a headache disorder.

  • Medication overuse headaches sometimes stop after you stop taking pain medication. It's powerful within the short term, however your doctor will assist you beat medication overuse headaches for long relief.

  • Medication overuse headaches (MOH) are caused by taking pain relievers more often or in larger amounts than the label recommends This may sound like a pretty common headache problem but it's actually much more serious It is also sometimes referred to as rebound headaches If you have MOH your doctor can help you get better and prevent future attacks.

  • Medication overuse headaches occur in people who take pain medication more than twice a week as well as those who suffer from migraines These types of headaches are likely to occur in people who have been taking migraine medication daily for more than three months Some medications that can cause medication overuse headaches include acetaminophen (Tylenol) narcotics and triptans which are commonly prescribed to treat migraines Medications used to stop nausea and vomiting may also be the culprits when it comes to medication overuse headache syndrome.

Symptoms Medication overuse headaches (MOH)

Symptoms of medication overuse headache vary in variety, severity and site. This is often as a result of the headaches themselves taking issue and since folks that have headaches take differing types and frequency of medication.

Signs and symptoms of medication overuse headaches could take issue per the kind of original headache being treated and therefore the medication used. Medication overuse headaches tend to:

  • Occur every day or nearly every day, often waking you in the early morning

  • Improve with pain relief medication but then return as your medication wears off

Other signs and symptoms may include:

  • Nausea

  • Restlessness

  • Difficulty concentrating

  • Memory problems

  • Irritability

When to see a doctor

Occasional headaches are a common unit. However, it is vital to take your headaches seriously. Some forms of headaches are dangerous.

Seek immediate medical care if your headache:

  • Is sudden and severe

  • Accompanies a fever, stiff neck, rash, confusion, seizure, double vision, weakness, numbness or difficulty speaking

  • Follows a head injury

  • Gets worse despite rest and pain medication

  • Is a new type that's persistent, especially in someone older than 50

  • Occurs with shortness of breath

  • Happens when you're upright but goes away if you're lying flat

Consult your doctor if:

  • You usually have two or more headaches a week

  • You take a pain reliever for your headaches more than twice a week

  • You need more than the recommended dose of over-the-counter pain remedies to relieve your headaches

  • Your headache pattern changes

Causes Medication overuse headaches (MOH)

When you get headaches, you presumably take your acute (immediate-relief) medication. However, if your headaches aren't well controlled and you develop additional headaches, you'll take additional and additional as-needed medication to manage your headache. Therefore this regeneration of taking additional and additional pain-relieving medications to lessen your headache really results in the event of daily or nearly daily headaches.

Technically, medication overuse headache is outlined as having headaches on fifteen or additional days a month in somebody World Health Organization includes a persistent headache disorder World Health Organization has been taking one or additional acute medications to alleviate symptoms for a minimum of 3 months and World Health Organization has no different well-known cause for his or her headache.

Doctors do not nevertheless recognize precisely why medication overuse results in rebound headaches. the chance of developing medication overuse headaches varies counting on the medication, however any acute headache medication has the potential to guide to medication overuse headaches, including:

  • Simple pain relievers. Common pain relievers like acetylsalicylic acid and Tempra (Tylenol, others) could contribute to medication overuse headaches — particularly if you exceed the suggested daily dosages. Pain relievers like Advil (Advil, Motrin IB, others) and nonsteroidal anti-inflammatory drugs (Aleve) have a coffee risk of tributary to medication overuse headaches .

  • Combination pain relievers. Over-the-counter (OTC) pain relievers that mix caffeine, anodyne and painkillers (Excedrin, others) are common culprits.
    This cluster additionally includes prescription medications like Fiorinal, that contains the sedative butalbital. Butalbital-containing compounds have Associate in Nursing particularly high risk of inflicting medication overuse headaches, thus it is best to not take them to treat headaches. 

  • Migraine medications. Various headache medications are joined with medication overuse headaches, together with triptans (Imitrex, Zomig, others) and sure ergots — like alkaloid (Ergomar, others). These medications have a moderate risk of inflicting medication overuse headaches. The ergot dihydroergotamine (D.H.E. 45) seems to possess a lower potential for this downside. 

  • Opiates. Painkillers derived from controlled substances or from artificial controlled substance compounds embody mixtures of painkillers and Tylenol (Tylenol with painkillers No. 3 and No. 4, others). These medications have a high risk of inflicting medication overuse headaches.
    Daily doses of caffeine — from occasional soda, and pain relievers and different products containing this delicate stimulant — could fuel medication overuse headaches, as well. browse product labels to form positive you are not wiring your system with additional caffeine than you understand. 

Risk factors Medication overuse headaches (MOH)

Risk factors for developing medication overuse headaches include:

  • History of chronic headaches. A history of chronic headaches, especially migraines, puts you at risk.

  • Frequent use of headache medications. Your risk will increase if you employ combination analgesics, alkaloid or triptans ten or a lot of days a month or easy analgesics quite fifteen days a month — particularly if this regular use continues for 3 or a lot of months. 

How do you get rid of rebound headaches?

To prevent or eliminate rebound one must avoid consuming as much caffeine as possible To begin eliminating coffee and other caffeinated beverages start by switching to decaffeinated coffee and tea Each day try reducing the amount of caffeine consumed by half until you are off all caffeinated products The withdrawal symptoms usually fade after a week A natural headache remedy may help relieve any pain while the body is adjusting to being free from caffeine addiction An excellent homeopathic option for this transition is Pulsatilla 30C taken several times daily in decreasing dosages as symptoms dissipate Check out 9 more tips for stopping your caffeine dependency.

How long does it take to develop medication overuse headache?

A person begins to develop medication overuse headache when they take too many of the same medications repeatedly and on a regular basis These medicines include pain relievers such as: -–Aspirin; -–Ibuprofen (Advil or Motrin); and -–Naproxen sodium (Aleve or Naprosyn).

How long does it take to recover from rebound headaches?

Some types of headaches are caused by nervous system imbalances or biomechanical faults that are not easily remedied When looking for solutions rebound headaches might be a possibility to consider It happens when people depend on pain-killing medication after experiencing chronic daily headaches They eventually stop taking the medication but the body continues to rely on it and causes the head to hurt even more because the pain is no longer being treated However it can take up to two weeks before any improvement in symptoms occurs with this type of headache treatment approach.

How does ibuprofen stop rebound headaches?

web tab free free web icon for?-web-icon (25px) copy web?-icon-blk | Copy the code below and paste it into your webpage.

How do I know if it's a rebound headache?

Interruptions in sleep habits such as changing to a new sleeping environment or time zone and insomnia are the main causes of headaches. A person who gets adequate restful sleep can expect a headache-free day every day.

Why won't my headache go away after taking medicine?

Even if you take headache medicine as soon as you feel the first twinge it may not provide relief Many over-the-counter drugs work best when taken at the first sign of pain; others will actually make your headache worse if taken in advance Also some simple remedies such as heat and rest are more effective than medications for certain types of headache.

Prevention Medication overuse headaches

To help prevent medication overuse headaches:

  • Take your headache medication as prescribed.

  • If you need headache medication more than twice a week, contact your doctor.

  • Avoid medications that contain butalbital or opioids.

  • Use OTC painkillers less than 15 days a month.

  • Limit use of triptans or combination analgesics to no more than nine days a month.

Taking care of yourself can help prevent most headaches.

  • Avoid headache triggers. If you are not certain what triggers your headaches, keep a headache diary with details concerning each headache. Eventually, you'll see a pattern. 

  • Get enough sleep. Go to bed and wake up at the same time every day — even on weekends.

  • Don't skip meals. Start your day with a healthy breakfast. Eat lunch and dinner at about the same time every day.

  • Stay hydrated. Be sure to drink plenty of water or other non caffeinated fluids.

  • Exercise regularly. Physical activity causes your body to release chemicals that block pain signals to your brain. With your doctor's OK, choose activities you enjoy — such as walking, swimming or cycling.

  • Reduce stress. Get organized. Simplify your schedule, and plan ahead. Try to stay positive.

  • Lose weight. Obesity can contribute to headache development, so if you need to lose weight, find a program that works for you.

  • Quit smoking. If you smoke, talk to your doctor about quitting. Smoking is linked to a higher risk of medication overuse headaches.

Diagnosis Medication overuse headaches (MOH)

The identification for medication-overuse headache is clinical, and a history of analgesic use quite 2 to 3 days per week in an exceedingly patient with chronic daily headache is revealing of this identification. The doc could think about playing further tests like imaging studies and science lab work, particularly if the standard of the headaches changes to rule out the other secondary cause. This identification is supported if headache frequency will increase in response to increasing medication use, or improves once the overused medication is withdrawn.

Your doctor can usually diagnose medication overuse headaches based on a history of chronic headaches and frequent use of medication. Testing usually isn't necessary.

Treatment Medication overuse headaches (MOH)

Discontinuation of overused medication is important and also the treatment of alternatives for MOH. Additionally, preventive treatment aimed toward the suspected background primary headache disorders ought to be initiated either throughout or instantly following withdrawal.4,5 There area unit varied ways to assist with method of medication withdrawal and bridge medical aid could also be helpful throughout ending to produce symptomatic relief. except discontinuance, a mix of pharmacologic medical aid, non-pharmacological medical aid, training program, and targeted physiotherapy is required for improvement within the patient’s symptoms. Support teams and behavioral techniques have additionally been found necessary for the success of the treatment within the symptoms.

It is vital for the patient to grasp that once the medication overused is out of print, they {will} bear a amount wherever their headaches will worsen. Another symptom caused by the withdrawal of the medication will embody nausea, vomiting, insomnia, restlessness or constipation. The headaches eventually can be regained.

The doc can decide if the overused medication is out of print or if it has to be tapered slowly. It's going to take one or two months to 6 months to eventually break the headache cycle.

In bound circumstances, patient treatment could also be thought-about so medication will be tapered in a very controlled atmosphere, and prolonged intravenous medications will be wont to break the headache cycle.

Other patient therapies embody training programs, psychological substance, and physiotherapy, that facilitate effective work on a dynamic life-style and incorporating non pharmacologic therapies for the management of headaches. The training program teaches the patient to manage bound responses of the body to effectively facilitate in reducing pain. The patient learns diaphragmatic respiration and the way to manage temperature, heart rate, and muscle tension to enter into a relaxed state, which can facilitate a higher deal with pain.

To break the cycle of medication overuse headaches, you'll have to limit your pain medication. counting on the drug you are taking, your doctor might suggest stopping the medication at once or step by step reducing the dose.

Breaking the cycle

When you stop your medication, expect your headaches to get worse before they recover. Drug dependency could also be a risk issue for medication that lead to medication overuse headaches, and you'll have withdrawal symptoms such as:

  • Nervousness

  • Restlessness

  • Nausea

  • Vomiting

  • Insomnia

  • Constipation

These symptoms usually last from 2 to ten days, however they will persist for many weeks.

Your doctor might order varied treatments to assist alleviate headache pain and also the aspect effects related to conclusion. This can be referred to as bridge or shift medical care. Treatments might embrace NSAID medication, corticosteroids or dihydroergotamine, Associate in Nursing ergot that will tend through a vein (intravenously).

There's discussion over what proportion profit bridge medical care might provide, and whether or not or not one drug is simpler than others. Withdrawal headaches tend to boost in but per week.


Sometimes it is best to be in a controlled surroundings once you stop taking pain medication. a brief hospital keep could also be suggested if you:

  • Have other conditions, such as depression or anxiety

  • Are taking high doses of drugs that contain opiates or the sedative butalbital

  • Are abusing substances such as tranquilizers, opioids or barbiturates

Preventive medications

Preventive medications might assist you break the cycle of medication overuse headaches. Work along with your doctor to avoid reverting and to search out a safer thanks to manage your headaches. throughout or when withdrawal, your doctor might dictate any of the subsequent daily preventive medications:

  • An anticonvulsant such as topiramate (Topamax, Qudexy XR, Trokendi XR)

  • A tricyclic antidepressant such as amitriptyline or nortriptyline (Pamelor)

  • A beta blocker such as propranolol (Inderal, Innopran XL)

  • A calcium channel blocker, such as verapamil (Calan, Verelan, others)

These medications will facilitate management of your pain while not risking medication overuse headaches. If you are careful, you will be able to take a medicine specifically meant for pain throughout future headache attacks. make sure to require medications precisely as prescribed.


Injections of onabotulinumtoxinA (Botox) might facilitate cutting back the quantity of headaches per month in addition to headache severity.

Cognitive behavioral therapy (CBT)

During this speech, you learn ways to address your headaches. In CBT, you furthermore may work on healthy mode habits and keeping a headache diary.

Alternative medicine

For many individuals, complementary or different therapies provide relief from headache pain. However, not all complementary or different therapies are studied as headache treatments, et al. want more analysis. Discuss the risks and edges of complementary medical care along with your doctor.

Possible therapies include:

  • Acupuncture. This ancient technique uses fine needles to market the discharge of natural painkillers and alternative chemicals within the central system. This medical aid could ease headaches. 

  • Biofeedback. Biofeedback teaches you to regulate bound body responses that facilitate cut back pain. Throughout a session, you are connected to devices that monitor and provide you feedback on body functions, like muscle tension, vital sign and pressure level. You then find out how to scale back muscle tension and slow your vital sign and respiration to assist you relax, which can assist you deal with pain. 

  • Herbs, vitamins and minerals. Some dietary supplements — together with metallic elements, ovoflavin (vitamin B2), herbaceous plant and molecule Q10 — appear to assist forestall or treat some kinds of headaches, however there is very little scientific support for these claims. If you are considering victimization supplements, discuss with your doctor. Some supplements could interfere with alternative medication you are taking or produce other harmful effects. 

Preparing for your appointment

You're able to begin by seeing your general practitioner or a medico. you'll then be remarked a doctor United Nations agency makes a speciality of system disorders (neurologist).

Here's some info to assist you prepare for your appointment.

What you can do

  • Keep a headache diary. Write down your symptoms, even people who appear unrelated to headaches. Note what you were doing, uptake or drinking before the headache began, however long the headache lasted, and also the medications and amounts you took to treat the headache. 

  • Write down key personal information, including major stresses or recent life changes.

  • List questions to ask your doctor.

For medication overuse headaches, some questions to ask your doctor include:

  • How could I cause a headache with medicine I took to treat a headache?

  • Could there be other reasons for my headaches?

  • How can I stop these headaches?

  • Are there alternatives to the approach you're suggesting?

  • If my original headaches return, how can I treat them?

  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask any other questions.

What to expect from your doctor

The doctor will ask questions about your headaches, such as when they started and what they feel like. The more the doctor knows about your headaches and medication use, the better care he or she will be able to provide. Your doctor may ask:

  • What type of headache do you usually have?

  • Have your headaches changed in the past six months?

  • How severe are your symptoms?

  • What headache medications do you use, and how often?

  • Have you increased the amount or frequency of taking them?

  • What side effects have you had from medications?

  • Does anything help improve your symptoms?

  • What, if anything, appears to worsen your symptoms?

What you can do in the meantime

Until your appointment, take your medication solely as directed by your doctor, and pay attention to yourself. Healthy way habits — like obtaining adequate sleep, consumption of many fruits and vegetables, and obtaining regular exercise — will facilitate forestall headaches. Avoid any best-known headache triggers.

A headache diary may be terribly useful for your doctor. Keep track of once your headaches occur, their severity and period, what you were doing once the headache began, and what your response to the headache was.

General summary

  1. Medication overuse headache is a condition in which common pain relievers such as aspirin and ibuprofen are used for headaches more often than recommended. If you think that you may be suffering from medication overuse headache, talk to your doctor or visit.

Next Post Previous Post