MOH develops from using acute headache medicines excessively. It’s not about being addicted; it’s about how your brain processes pain when certain medicines are taken too frequently.
Common Culprits and How Much is Too Much:
Triptans (like sumatriptan, zolmitriptan, eletriptan) and Ergotamines: Overuse occurs when taken 10 or more days per month.
Opioids (like oxycodone, hydrocodone, tramadol, codeine, or combinations containing them): High risk for MOH when used 10 or more days per month.
Combination Pain Relievers (those mixing caffeine, aspirin, and acetaminophen, or containing butalbital): High risk for MOH when used 10 or more days per month. Butalbital-containing medicines are particularly risky and should be avoided for headaches.
Simple Pain Relievers (like aspirin, acetaminophen, ibuprofen, naproxen, indomethacin): Can cause MOH when used 15 or more days per month. Taking more than recommended daily doses also increases the risk.
Caffeine: Intake of more than 200mg per day increases the risk of MOH.
MOH typically occurs in people who already have primary headache disorders like migraine or tension-type headaches. A history of frequent headaches or substance use disorders also increases the risk.
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The symptoms of MOH can vary, but generally, the headaches, which happen daily or almost daily, often present upon waking.
Briefly improve with pain medicine, only to return as the medicine wears off.
Other common symptoms that may come with these headaches include:
Nausea and/or vomiting
Anxiety
Irritability
Restlessness
Difficulty concentrating
Memory problems
Feeling very tired (asthenia)
Depression
Medication overuse headache can make your headache problem much harder to control.
It can make preventive treatments less effective, meaning the medicines designed to stop headaches from happening frequently might not work as well.
It also reduces how well acute pain relief medications work when you do take them.
Continuous medication overuse increases the risk of your headaches becoming chronic migraine.
Long-term overuse of certain medicines can lead to other health issues, such as liver damage from acetaminophen or stomach bleeding from NSAIDs.
If you experience any of the following, it’s important to talk to your healthcare provider:
You have headaches two or more days a week.
You use acute headache medications more than 10-15 days per month.
Your headaches are getting worse or more frequent despite using medication.
Your headache pattern changes, or you need more than the recommended dose of over-the-counter pain relievers.
The most important step to treat MOH is to stop using the overused medication. This can be challenging, but it’s essential to break the cycle and allow your brain’s pain pathways to reset.
Your doctor will help you create a plan for withdrawal, which might involve:
Stopping “Cold Turkey” or Gradually Reducing Medication: Sometimes, stopping all at once is effective, especially for simpler cases. For other medications, like opioids or butalbital, a slow reduction (tapering) is safer and necessary to prevent serious withdrawal symptoms.
“Bridge Therapy”: These are temporary medications given during withdrawal to help ease the increased headache pain and other withdrawal symptoms. Examples include certain anti-inflammatory drugs, steroids, or anti-nausea medications.
Inpatient Treatment: In some situations, especially if you’re taking high doses of opioids or butalbital, or have other health concerns like severe anxiety or depression, a hospital stay might be recommended to manage withdrawal in a controlled environment.
Other Important Treatments to Help You Recover: Preventive Medications: These are daily medications aimed at treating your underlying headache disorder (like migraine) and reducing headache frequency overall. They can be started during or after withdrawal.
Lifestyle Management: Adopting healthy habits is crucial. This includes:
Sleep: Aim for regular sleep patterns, a dark, quiet, and cool bedroom.
Exercise: Engage in regular physical activity, 30-60 minutes, 3-5 times a week.
Eat: Eat regular, healthy meals, stay well-hydrated, and limit caffeine intake to less than 200mg/day. Avoid skipping meals.
Diary: Keep a headache diary to track your headaches, symptoms, and medication use. This helps you and your doctor understand patterns and tailor treatment.
Stress: Learn stress management techniques like biofeedback, cognitive behavioral therapy, mindfulness, and relaxation exercises.
Support Groups: Connecting with others who understand your experience can provide valuable encouragement and support.
It’s important to know that when you stop the overused medication, your headaches may actually get worse before they get better. This is a normal part of the process, and it usually takes about 2 to 10 days, but can sometimes last weeks or even a few months for the brain’s pain mechanisms to calm down.
You might also experience other withdrawal symptoms, such as:
Nausea and vomiting
Trouble sleeping (insomnia)
Restlessness
Constipation or stomach upset
Increased anxiety or low mood
These symptoms are often temporary and will improve as your body adjusts. It takes willpower and commitment, but over 50% of people see significant improvement and can return to having headaches less frequently after a successful withdrawal. However, some people might relapse and start overusing medications again, so staying vigilant and working with your doctor is key.
To avoid MOH in the future, it’s crucial to:
Limit acute pain relief medications to no more than two days per week in total.
Specifically, limit triptans and ergotamines to less than 10 days per month.
Limit simple pain relievers (like ibuprofen or acetaminophen) to less than 15 days per month.
Avoid opioid medications and butalbital combinations for headaches altogether.
Keep a headache diary to track your medication use and headache patterns.
If you find yourself needing acute treatment frequently, contact your doctor so appropriate management can be done, and MOH can be prevented.
Discuss starting preventive treatments early if your acute medication intake is increasing.
Maintain a healthy lifestyle, including regular sleep, exercise, balanced diet, good hydration, and stress management.
