Medication overuse headache as a consequence of taking painkillers – a review of current literature
DOI:
https://doi.org/10.56782/pps.149Keywords:
Drug-induced headache, Medication overuse headache, MOH, chronic headache, painkillersAbstract
Introduction: Many people use painkillers to stop a headache, not realizing that the misuse of these substances can cause this pain. Patients often use OTC drugs and do not treat these drugs as potentially dangerous. A pattern where a person with pain takes more and more pain-inducing drugs can lead to addiction. In the Polish literature, you can find terms such as “rebound headache” or “drug-induced headache”. The current International Classification of Headaches 3 beta uses the term 'medication overuse headache' (MOH). This name suggests the occurrence of headaches as a consequence of the abuse of any medical preparations, but according to the classification, it is associated only with the abuse of a drug or drugs used in acute pain therapy. Ból głowy z nadużywania leków przeciwbólowych – przegląd aktualnej literatury
The aim of the study: This study aims to gather and summarize current knowledge about etiology, epidemiology and treatment in MOH - medication overuse headache.
Materials and methods: This review was based on available data collected in the PubMed database and Google Scholar web search engine, using following terms: ‘Medication overuse headache’, ‘main risk factors for MOH’, ‘pathophysiology of drug-induced headaches’, ‘treatment of medication-misuse headache’.
Conclusion: Medication overuse headache is a worldwide problem. There are many risk factors responsible for the development of this disease. Some of them are modifiable, so physicians should educate patients and their families about the tolerance of the doses and possible addictions. Large-scale randomized clinical trials are needed to compare different treatment regimens and determine the best evidence-based approach. Until then, the focus should be on raising awareness of MOH in the general population. Treatment requires an individual approach to the patient. Regular check-ups after treatment are important to prevent recurrence of the disease.
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References
GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017, 16(11), 877–897, doi: 10.1016/S1474-4422(17)30299-5. DOI: https://doi.org/10.1016/S1474-4422(17)30299-5
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013, 33(9), 629–808, doi: 10.1177/0333102413485658. DOI: https://doi.org/10.1177/0333102413485658
Boes, CJ; Capobianco, DJ. Chronic migraine and medication-overuse headache through the ages. Cephalalgia 2005, 25(5), 378-90. DOI: 10.1111/j.1468-2982.2005.00868.x DOI: https://doi.org/10.1111/j.1468-2982.2005.00868.x
Mathew, NT.; Reuveni, U.; Perez, F. Transformed or evolutive migraine. Headache 1987, 27(2),102-6. https://doi.org/10.1111/j.1526-4610.1987.hed2702102.x DOI: https://doi.org/10.1111/j.1526-4610.1987.hed2702102.x
Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Headache Classification Committee of the International Headache Society. Cephalalgia 1988, 8 Suppl 7, 1-96.
Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004, 24 Suppl 1, 9-160. DOI: 10.1111/j.1468-2982.2003.00824.x DOI: https://doi.org/10.1111/j.1468-2982.2003.00824.x
Sieminski, M. Tension-type headache in primary care. Forum Med. Rodz. 2017, 11( 6), 255-262.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018, 38(1), 1-211. DOI: 10.1177/0333102417738202 DOI: https://doi.org/10.1177/0333102417738202
Dripps, I.J.; Bertels, Z.; Moye, L.S.; Tipton, A.F.; Siegersma, K.; Baca, S.M.; Kieffer, B.L.; Pradhan, A.A. Forebrain delta opioid receptors regulate the response of delta agonist in models of migraine and opioid-induced hyperalgesia. Sci. Rep. 2020, 10(1), 17629. DOI: https://doi.org/10.1038/s41598-020-74605-9 DOI: https://doi.org/10.1038/s41598-020-74605-9
Aleksenko, D.; Maini, K.; Sánchez-Manso, J.C. Medication Overuse Induced Headache. [Updated 2022 Jul 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470171/
Di Lorenzo, C.; Coppola, G.; Currà, A.; Grieco, G.; Santorelli, FM.; Lepre, C.; Porretta, E.; Pascale, E.; Pierelli, F. Cortical response to somatosensory stimulation in medication overuse headache patients is influenced by angiotensin converting enzyme (ACE) I/D genetic polymorphism. Cephalalgia 2012, 32(16), 1189-97. DOI: 10.1177/0333102412461890 DOI: https://doi.org/10.1177/0333102412461890
Binder, D..K.; Scharfman, H.E. Brain-derived neurotrophic factor. Growth Factors 2004, 22(3), 123-31. DOI: 10.1080/08977190410001723308 DOI: https://doi.org/10.1080/08977190410001723308
Andersen, S.; Skorpen, F. Variation in the COMT gene: implications for pain perception and pain treatment. Pharmacogenomics 2009, 10(4), 669-84. DOI: 10.1080/08977190410001723308 DOI: https://doi.org/10.2217/pgs.09.13
Serretti, A.; Calati, R.; Mandelli, L.; De Ronchi, D. Serotonin transporter gene variants and behavior: a comprehensive review. Curr. Drug Targets 2006, 7(12), 1659-69. DOI: 10.2174/138945006779025419 DOI: https://doi.org/10.2174/138945006779025419
De Felice, M.; Ossipov, M.H.; Wang, R.; Lai, J.; Chichorro, J.; Meng, I.; Dodick, DW.; Vanderah, T.W.; Dussor, G.; Porreca, F. Triptan-induced latent sensitization: a possible basis for medication overuse headache. Ann. Neurol. 2010, 67(3), 325-37. DOI: 10.1002/ana.21897 DOI: https://doi.org/10.1002/ana.21897
Zwart, JA.; Dyb, G.; Hagen, K. et al. Analgesic use: a predictor of chronic pain and medication overuse headache: the Head-HUNT Study. Neurology 2003, 61(2), 160–164. DOI: 10.1212/01.wnl.0000069924.69078.8d DOI: https://doi.org/10.1212/01.WNL.0000069924.69078.8D
Thorlund, K.; Sun-Edelstein, C.; Druyts, E.; Kanters, S.; Ebrahim, S.; Bhambri, R.; Ramos, E.; Mills, E.J.; Lanteri-Minet, M.; Tepper, S. Risk of medication overuse headache across classes of treatments for acute migraine. J. Headache Pain 2016, 17(1), 107. DOI: 10.1186/s10194-016-0696-8. DOI: https://doi.org/10.1186/s10194-016-0696-8
Łukasik, M. Ból głowy z nadużywania leków. Polski Przegląd Neurologiczny 2017, 13(1).
Shahbeigi, S.; Fereshtehnejad, S.M.; Mohammadi, N.; Golmakani, MM.; Tadayyon, S.; Jalilzadeh, G.; Pakdaman, H. Epidemiology of headaches in Tehran urban area: a population-based cross-sectional study in district 8, year 2010. Neurol. Sci. 2013, 34(7), 1157-66. DOI: 10.1007/s10072-012-1200-0 DOI: https://doi.org/10.1007/s10072-012-1200-0
Kulkarni, G.B.; Mathew, T.; Mailankody, P. Medication Overuse Headache. Neurol India 2021, 69(Supplement), S76-S82. DOI: 10.4103/0028-3886.315981 DOI: https://doi.org/10.4103/0028-3886.315981
Jonsson, P.; Linde, M.; Hensing, G. et al. Sociodemographic differences in medication use, health-care contacts and sickness absence among individuals with medication-overuse headache. J. Headache Pain 2012, 13(4), 281–290, DOI: 10.1007/s10194-012-0432-y. DOI: https://doi.org/10.1007/s10194-012-0432-y
Westergaard, M.L.; Glümer C.; Hansen, E.H. et al. Prevalence of chronic headache with and without medication overuse: associations with socioeconomic position and physical and mental health status. Pain 2014, 155(10), 2005–2013, doi: 10.1016/j.pain.2014.07.002. DOI: https://doi.org/10.1016/j.pain.2014.07.002
GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017, 390(10100), 1345-1422. DOI: 10.1016/S0140-6736(17)32366-8 DOI: https://doi.org/10.1016/S0140-6736(17)32366-8
Hagen, K.; Linde, M.; Steiner, T.J.; Stovner, L.J.; Zwart, J.A. Risk factors for medication-overuse headache: an 11-year follow-up study. The Nord-Trøndelag Health Studies. Pain 2012, 153(1), 56-61. DOI: 10.1016/j.pain.2011.08.018 DOI: https://doi.org/10.1016/j.pain.2011.08.018
Scher, A.I.; Lipton, R.B.; Stewart, W.F.; Bigal, M. Patterns of medication use by chronic and episodic headache sufferers in the general population: results from the frequent headache epidemiology study. Cephalalgia 2010, 30(3), 321-8. DOI: 10.1111/j.1468-2982.2009.01913.x DOI: https://doi.org/10.1111/j.1468-2982.2009.01913.x
He, Z.; Dong, L.; Zhang, Y.; Kong, Q.; Tan, G.; Zhou, J. Metabolic syndrome in female migraine patients is associated with medication overuse headache: a clinic-based study in China. Eur. J. Neurol. 2015, 22(8), 1228-34. DOI: 10.1111/ene.12732 DOI: https://doi.org/10.1111/ene.12732
Rapoport, A.M. Medication overuse headache: awareness, detection and treatment. CNS Drugs 2008, 22(12), 995-1004. DOI: 10.2165/0023210-200822120-00003 DOI: https://doi.org/10.2165/0023210-200822120-00003
Lagman-Bartolome, A.M.; Lawler, V.; Lay, C. Headache Education Active-Waiting Directive: A Program to Enhance Well-Being During Long Referral Wait Times. Headache 2018, 58(1), 109-117. DOI: 10.1111/head.13194 DOI: https://doi.org/10.1111/head.13194
Rossi, P.; Di Lorenzo, C.; Faroni, J.; Cesarino, F.; Nappi, G. Advice alone vs. structured detoxification programmes for medication overuse headache: a prospective, randomized, open-label trial in transformed migraine patients with low medical needs. Cephalalgia 2006, 26(9), 1097-105. DOI: 10.1111/j.1468-2982.2006.01175.x DOI: https://doi.org/10.1111/j.1468-2982.2006.01175.x
Schwedt, T.J.; Hentz, J.G.; Sahai-Srivastava, S.; Murinova, N.; Spare, N.M.; Treppendahl, C.; Martin, V.T.; Birlea, M.; Digre, K.; Watson, D.; Leonard, M.; Robert, T.; Dodick, D.W.; MOTS Investigators. Patient-Centered Treatment of Chronic Migraine With Medication Overuse: A Prospective, Randomized, Pragmatic Clinical Trial. Neurology 2022, 98(14), e1409-e1421. DOI: 10.1212/WNL.0000000000200117 DOI: https://doi.org/10.1212/WNL.0000000000200117
Cheung, V.; Amoozegar, F.; Dilli, E. Medication overuse headache. Curr. Neurol. Neurosci. Rep. 2015, 15(1), 509. DOI: 10.1007/s11910-014-0509-x DOI: https://doi.org/10.1007/s11910-014-0509-x
Saper, J.R.; Da Silva, A.N. Medication overuse headache: history, features, prevention and management strategies. CNS Drugs 2013, 27(11), 867-77. DOI: 10.1007/s40263-013-0081-y DOI: https://doi.org/10.1007/s40263-013-0081-y
Diener, H.C.; Dodick, D.W.; Goadsby, P.J.; Bigal, M.E.; Bussone, G.; Silberstein, S.D.; Mathew, N.; Ascher, S.; Morein, J.; Hulihan, J.F.; Biondi, D.M.; Greenberg, S.J. Utility of topiramate for the treatment of patients with chronic migraine in the presence or absence of acute medication overuse. Cephalalgia 2009, 29(10), 1021-7. DOI: 10.1111/j.1468-2982.2009.01859.x DOI: https://doi.org/10.1111/j.1468-2982.2009.01859.x
Russell, M.B.; Lundqvist, C. Prevention and management of medication overuse headache. Curr. Opin. Neurol. 2012, 25(3), 290-5. DOI: 10.1097/WCO.0b013e328352c431 DOI: https://doi.org/10.1097/WCO.0b013e328352c431
Aurora, S.K.; Dodick, D.W.; Turkel, C.C.; DeGryse, R.E.; Silberstein, S.D.; Lipton, R.B.; Diener, H.C.; Brin, M.F.; PREEMPT 1 Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia 2010, 30(7), 793-803. DOI: 10.1177/0333102410364676 DOI: https://doi.org/10.1177/0333102410364676
Diener, H.C.; Dodick, D.W.; Aurora, S.K.; Turkel, C.C.; DeGryse, R.E.; Lipton, R.B.; Silberstein, S.D.; Brin, M.F. PREEMPT 2 Chronic Migraine Study Group. OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia 2010, 30(7), 804-14. DOI: 10.1177/0333102410364677 DOI: https://doi.org/10.1177/0333102410364677
Silberstein, S.D.; Blumenfeld, A.M.; Cady, R.K.; Turner, I.M.; Lipton, R.B.; Diener, H.C.; Aurora, S.K.; Sirimanne, M.; DeGryse, R.E.; Turkel, C.C.; Dodick, D.W. OnabotulinumtoxinA for treatment of chronic migraine: PREEMPT 24-week pooled subgroup analysis of patients who had acute headache medication overuse at baseline.
J. Neurol. Sci. 2013, 331(1-2), 48-56. DOI: 10.1016/j.jns.2013.05.003 DOI: https://doi.org/10.1016/j.jns.2013.05.003
Bendtsen, L.; Munksgaard, S.; Tassorelli, C.; Nappi, G.; Katsarava, Z.; Lainez, M.; Leston, J.; Fadic, R.; Spadafora, S.; Stoppini, A.; Jensen, R.; COMOESTAS Consortium. Disability, anxiety and depression associated with medication-overuse headache can be considerably reduced by detoxification and prophylactic treatment. Results from a multicentre, multinational study (COMOESTAS project). Cephalalgia. 2014, 34(6), 426-33. DOI: 10.1177/0333102413515338 DOI: https://doi.org/10.1177/0333102413515338
Tassorelli, C.; Jensen, R.; Allena, M.; De Icco, R.; Sances, G.; Katsarava, Z.; Lainez, M.; Leston, J.; Fadic, R.; Spadafora, S.; Pagani, M.; Nappi, G.; the COMOESTAS Consortium. A consensus protocol for the management of medication-overuse headache: Evaluation in a multicentric, multinational study. Cephalalgia 2014, 34(9), 645-655. DOI: 10.1177/0333102414521508 DOI: https://doi.org/10.1177/0333102414521508
Pascual, J.; Berciano, J. [Daily chronic headache in patients with migraine induced by abuse of ergotamine-analgesics: response due to a protocol of outpatient treatment]. Neurologia 1993, 8(7),212-5.
Tepper, D. Medication Overuse Headache. Headache 2017, 57(5), 845-846. https://doi.org/10.1111/head.13034 DOI: https://doi.org/10.1111/head.13034
Williams, DR.; Stark, RJ. Intravenous lignocaine (lidocaine) infusion for the treatment of chronic daily headache with substantial medication overuse. Cephalalgia 2003, 23(10), 963-71. doi: 10.1046/j.1468-2982.2003.00623.x DOI: https://doi.org/10.1046/j.1468-2982.2003.00623.x
Trucco, M.; Meineri, P.; Ruiz, L.; Gionco, M.; Gruppo Neurologico Ospedaliero Interregionale per lo Studio delle Cefalee (Neurological Hospital Interregional Group for the Study of Headaches). Medication overuse headache: withdrawal and prophylactic therapeutic regimen. Headache 2010, 50(6), 989-97. DOI: 10.1111/j.1526-4610.2010.01631.x DOI: https://doi.org/10.1111/j.1526-4610.2010.01631.x
Bottiroli, S.; Galli, F.; Viana, M.; De Icco, R.; Bitetto, V.; Allena, M.; Pazzi, S.; Sances, G.; Tassorelli, C. Negative Short-Term Outcome of Detoxification Therapy in Chronic Migraine With Medication Overuse Headache: Role for Early Life Traumatic Experiences and Recent Stressful Events. Front. Neurol. 2019, 10, 173. DOI: 10.3389/fneur.2019.00173 DOI: https://doi.org/10.3389/fneur.2019.00173
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