Medication Overuse Headaches

Is your medication making your migraines worse?

Did you know one of the leading causes of chronic daily headaches (having headaches more than 15 days out of a month) is the over use of pain medication? Did you know the number one cause of medication over use is Excedrin?

What is Medication Overuse Headache?

Medication Overuse Headache (MOH) is a very frequent cause of chronic daily headaches. It has been reported as the cause of chronic daily headaches between 50-80% of the time. Medication Overuse Headache is also called rebound headache, analgesic rebound headache, or drug-induced headache. By definition it is having greater than 15 headaches a month for at least the past three months. Additionally, the headaches have to have worsened during the time of regular overuse of pain medication. Overuse is defined in terms of treatment days per month and depends on the drug.

Which medications cause Medication Overuse Headache?

The most common medication to cause Medication Overuse Headache is Excerdrin, followed by the Butalbital containing medications, then opioids. Triptans, Ergotamine, acetaminophen and NSAIDS may also cause Medication Overuse Headache but to a lesser degree.

How much medication is too much?

How much medication is too much depends on the offending medication. For the combination medications containing either Butalbital or opioids, triptans and ergotamine it can be as little as taking the medication >10 times a month to cause Medication Overuse Headache. For simple analgesics such as acetaminophen and NSAIDS,  Medication Overuse Headache is reported to occur with use >15 times per month.

How do I know if I have Medication Overuse Headaches?

Clinically, if you have Medication Overuse Headache, you may notice that you have to take more of a medication to treat the headache, or the medication that once previous worked is no longer treating your headaches. Often if the medication does decrease or relieve your headache, the headache will come back after the medication has worn off. That is why many people with Medication Overuse Headache will complain of headaches in the morning.

How do you treat Medication Overuse Headache?

Patients with Medication Overuse Headache can be difficult to treat. Typically, when you withdrawal the offending medication, the headache gets worse before it gets better. It is similar to what you experience when you stop drinking caffeine, the headaches can get worse while your body is going thru the withdrawal process. Sometimes getting off the over used medication requires a hospital stay both to help with the physical symptoms from the withdrawal of the medication and also the treatment of the headache. I also recommend starting a preventive medication to decrease the frequency of headaches thus decreasing the reliance on acute medication. However, preventive medications may not be as effective until they are off the offending medications, especially if they have been using opioids.

The best treatment for Medication Overuse Headache is prevention of it in the first place. One of the biggest reasons Medication Overuse Headache occurs is because the migraine is not properly being treated. Instead of using the most specific medication to treat a migraine such as a triptan, people start with either a over the counter medication which only partially decrease the pain, but is often not strong enough to completely get rid of the migraine. They often then try a Butalbital or opioid containing medication which may help them sleep but really has no effect on the migraine pathophysiology at all. Consequently, the migraine continues to build and thus becomes harder and harder to treat, requiring more and more medications and the cycle continues. The best treatment is using the most specific medication for migraine, ie triptans or ergotamines, but it is also just as important to use most the optimal dose and route for the treatment of their migraine.  Or as I described in earlier post, make sure you pull the weeds from the roots.

Now don’t get me wrong, Excedrin and other over the counter medication such as Aleve and Motrin can have a role in the treatment of migraines for some people, typically for mild or very infrequent headaches.   The problem occurs when people start taking these medications regularly. So if you buy this super size bottle of Excedrin and go thru it in a month much less in a year you may be causing a disservice to yourself and your migraines.