Definitions
A secondary headache disorder which develops as a consequence of regular overuse of one or more drugs
What is MOH?
Headache diary
How can headache symptoms and acute medication use be correlated?
Early withdrawal of overused medication
What is the mainstay/1st line treatment of MOH?
Thunderclap headahce, new onset in >50 yrs, focal neurological signs, evolution over days to weeks
Not well understood, may be related to central sensitisation or similar mechanisms to migraine or tension headaches.
What is the pathophysiology of Tension headaches?
Migraines
What is the most common primary headache type?
Triptans, Ergotamines and Simple analgesiacs
What drugs should be stopped abruptly in MOH?
Stress, Anxiety, Depression, Sleep disturbance
What are complications of MOH?
> 3 months
How long must medication be taken for to be classified as an overuse headache?
Typically describe their usual headache, though these symptoms may change overtime
Opioids, Barbiturates and benzodiazepines
What drugs should be tapered down over 2-4 weeks with MOH?
Medication of a different class
How should headaches be managed after withdrawal of the offending drug associated with MOH?
15 or more days per month
How often does a headache have to occur to allow for a diagnosis of MOH?
Daily headaches with features of migraine and tension-type headache?
Strong opioids, barbiturates or Tranquilisers
When should a specialist referral to neurology be made?
Skin hypersensitivity, runny nose, tearing, nausea, vomiting
What symptoms can be associated with MOH?
10 days or more a month
How often do Ergotamines, triptans, opioids or combination analgesiacs need to be taken a month for a MOH diagnosis?
Daily migraine-like headache or an increase in migraine frequency
How might Triptan overuse present with MOH?
Bridge therapy
What can be offered for patients with severe or frequent headaches? or Experience headaches on withdrawal of the causative medication?
1-2%
What is the 1-year worldwide prevalence of MOH?