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Updated January 05, 2015.
Do you find yourself popping an Advil a few times a week to curb an aching headache? Have you noticed a vicious cycle developing where if you stop taking the Advil--or other headache-alleviating medication--the headache recurs?
This is known as a medication overuse headache. Let's review the skinny on this type of chronic daily headache.
What Is Medication Overuse Headache (MOH)?
It's a headache that occurs on 15 days or more per month for at least 3 months AND develops as a result of overuse of acute pain-alleviating medication.
Overuse means taking medication on at least 10-15 days per month.
Who Gets Medication Overuse Headaches?
Anyone with a headache disorder can get them, but they are most common in those who suffer from episodic headache disorders, especially migraines or tension-type headaches.
How Common Is MOH?
It affects about 1-2 percent of the population and is more common in women.
What Does A MOH Feel Like?
It usually feels like a tension headache or a migraine and is often present upon awakening in the morning.
What Medications Cause MOH?
Any headache-alleviating medication can cause an MOH. The most common ones are:
- NSAIDs like Aleve (Naproxen) or Motrin, Advil (Ibuprofen)
- Over-the-counter combination medications like Aspirin/Acetaminophen/Caffeine
- Tylenol (Acetaminophen)
- Fiorcet (Butalbital/Acetaminophen/Caffeine)
- Opioids
- Triptans
- Ergotamine tartrate
What Is The Treatment For MOH?
Stopping the offending medication is critical. This is usually done abruptly, unless the medication puts you at high risk for serious withdrawal symptoms, like opiods.
In this case, your doctor may recommend a slower tapering of the drug over two to four weeks, or your doctor may recommend hospitalization during the withdrawal period.
With abrupt withdrawal of the medication, your doctor will ask that you followup closely so that he can monitor your symptoms. Followup is important so that you do not relapse, as your headache frequency and severity will likely worsen before it improves in the short-term.
During the time of withdrawal, your doctor may prescribe a long-acting NSAIDs, like Aleve (Naproxen) or a steroid, like prednisone, to help alleviate symptoms. Your doctor may also recommend starting a daily preventive headache medication.
Withdrawal symptoms vary depend on the type of medication you were taking but may include:
- Nausea and Vomiting
- Anxiety
- Restlessness
- Seizures (if taking a Butalbital-containing product)
- Worsening Headache
Once you have successfully withdrawn the medication, your doctor will review a proper treatment plan for you to help prevent headaches in the future and stop any acute attacks.
Generally speaking, over-the-counter combination medications (i.e. aspirin/acetaminophen/caffeine) and triptans should be limited to 9 or less days per month. NSAIDs should be limited to 15 or less days per month. Opiods and butalbital medications should be avoided for the regular management of primary headache disorders.
Please note: Do not make the diagnosis of MOH on your own and do not start or stop a new medication without consulting your healthcare provider.Â
Take Home Message
Medication overuse headache is a form of a chronic daily headache that can occur with the overuse of many types of over-the-counter and prescription medications. Fortunately, once diagnosed, it can be treated with careful withdrawal of the medication and close monitoring.
Sources
Abrams BM. Medication overuse headaches. Med Clin North Am 2013; 97:337-52.
Garza I, Scwedt TJ. Medication overuse headache: Etiology, clinical features, and diagnosis. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2014.
Garza I, Scwedt TJ. Medication overuse headache: Treatment and prognosis. In: UpToDate, Basow DS (Ed), UpToDate, Waltham, MA, 2014.
Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders: 2nd Edition". Cephalalgia 2004;24 Suppl 1:9-160.
DISCLAIMER: The information in this site is for educational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for diagnosis and treatment of any concerning symptoms or medical condition.