For many, managing headaches involves reaching for trusted medications that promise relief. But what happens when that relief becomes less effective over time, and your headaches seem to occur more often? You might unknowingly be caught in a cycle known as Medication Overuse Headache (MOH).
This condition doesn’t mean you’ve done something wrong—it’s an all-too-common response to frequent medication use in people seeking to control their headaches. Let’s explore MOH, what causes it, and how to break free from the cycle.
What Is Medication Overuse Headache?
Medication Overuse Headache (MOH), also known as rebound headache or medication adaptation headache, develops when certain headache medications are used too often. Over time, the brain becomes more sensitive to pain signals, and the very medications meant to provide relief can start to perpetuate the problem.
MOH is particularly common in individuals with pre-existing headache disorders, such as migraine or chronic tension-type headache, making it a secondary condition to these primary headache disorders.
What Does MOH Feel Like?
MOH doesn’t have a unique “signature,” which can make it tricky to recognize. Instead, the headaches often resemble the primary condition they stem from:
Migraine: If you usually experience migraine, MOH might feel like a worsening of your usual migraine symptoms, occurring more frequently. In fact, often migraine that is not well controlled can transform from being episodic to chronic and part of the reason for that is because of medication overuse headache.
Tension-Type Headaches: For tension headaches, MOH might appear as constant, dull, or pressure-like pain.
Often with medication overuse headache, the relief is transient—your headache subsides briefly after taking medication but returns quickly, often prompting more frequent use.
Why Does MOH Happen?
MOH is not a sign of misuse or addiction—it’s a physiological response to frequent medication use. Pain-relief medications, while helpful in moderation, can alter how the brain processes pain signals when taken too often. The result? A lower pain threshold and more frequent headaches.
What Types of Medications Can Cause MOH?
Medication Overuse Headache isn’t tied to one specific drug—it can occur with several types of headache treatments when they’re used too frequently. According to ICHD-3 criteria, the medications most commonly associated with MOH include:
Triptans
Often prescribed for migraines, these medications can contribute to MOH when used on 10 or more days per month.
Ergotamines
Medications like ergotamine tartrate, commonly used for migraines, have a similar risk when used excessively.
Opioids
Narcotic pain relievers, such as codeine, are associated with a higher risk of MOH when used on 10 or more days per month.
Simple Analgesics
Over-the-counter medications like acetaminophen (Tylenol®) and nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil®) or aspirin, can lead to MOH if used on 15 or more days per month.
Combination Medications
Products containing multiple active ingredients, such as caffeine, acetaminophen, or aspirin (e.g., Excedrin®), can cause MOH when used on 10 or more days per month.
It’s important to note that the risk of MOH varies depending on the type of medication, the frequency of use, and individual factors like a person’s underlying headache condition.
Breaking the Cycle: How to Treat MOH
The good news is that MOH is reversible. Recovery focuses on reducing medication overuse while addressing your underlying headache condition. Not all medications cause medication overuse headache. In fact, medication overuse headache is associated with abortive headache medications including NSAIDs (such as ibuprofen, acetaminophen, naproxen) and triptans (such as sumatriptan, naratriptan, rizatriptan). However, it is not associated with preventative medications.
Here are some tips to stop MOH:
Work with a Specialist:
Dr. Levi can develop a tailored plan that addresses both the MOH and your underlying headaches.
She can work with you to help you either stop or slowly reduce the use of the overused medication. Note, medications should never be abruptly stopped without the guidance of a healthcare professional.
Introduce Preventive Treatments:
Preventive medications can reduce headache frequency and severity without the risk of overuse. Options include beta-blockers, antidepressants, botox, or newer treatments like CGRP inhibitors.
Explore Non-Medication Therapies:
Behavioral approaches such as cognitive-behavioral therapy (CBT) can help manage stress and reduce reliance on medication.
Techniques like biofeedback, physical therapy, or relaxation exercises may also play a role.
Preventing MOH: Smart Headache Management
The best treatment for MOH is prevention. Here are practical tips to avoid falling into the cycle:
Limit Medication Use: Aim to use pain-relief medications no more than 2-3 days per week.
Recognize Triggers: Learn what might be triggering your headaches—stress, poor sleep, dehydration, or certain foods—and take steps to manage them.
Consider Preventive Options: For frequent headaches, preventive therapies can reduce the need for acute medication.
Hope Beyond the Headache
Living with frequent headaches is challenging, but MOH is a condition you can overcome. By understanding its features and working with a healthcare provider, you can take back control and regain a better quality of life.
If you suspect MOH, reach out to a specialist for guidance. Relief is possible, and the first step starts with asking for help.
Disclaimer: This blog post is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition.
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