Medication overuse headache (MOH) is a daily, or almost daily,
headache form that arises from overuse of one or more classes of
migraine-abortive or
analgesic medication. The main classes of drugs that cause MOH are
opioids,
butalbital-containing mixed
analgesics,
triptans,
ergotamine tartrate derivatives, simple
analgesics (except for plain
aspirin), and perhaps non-steroidal anti-inflammatory drugs. MOH can be debilitating and results from biochemical and functional brain changes induced by certain medications taken too frequently. At this time,
migraine and other
primary headache disorders in which
migraine or
migraine-like elements occur seem exclusively vulnerable to the development of MOH. Other
primary headache disorders are not currently believed to be vulnerable. The treatment of MOH consists of discontinuation of the offending
drug(s), acute treatment of the
withdrawal symptoms and escalating
pain, establishing a preventive treatment when necessary, and the implementation of educational and behavioral programs to prevent recidivism. In most patients, MOH can be treated in the outpatient setting but, for the most difficult cases, including those with
opioid or
butalbital overuse, or in patients with serious medical or behavioral disturbances, effective treatment requires a multidisciplinary, comprehensive
headache program, either day-hospital with infusion or an inpatient hospital setting.