neurologic disorders
Medication Overuse Headache
Treatment of Medication Overuse Headache
Medications to prevent the underlying headache disorder Withdrawal of the overused headache drug Use of rescue medications (eg, antipsychotic medications, corticosteroids,dihydroergotamine) for headache during the withdrawal period Cognitive therapy Biofeedback Education A patient with medication overuse headache can be treated in an outpatient or inpatient setting; sometimes IV medications are required. Patients with headache due to opioid overuse should be treated in an inpatient setting. Prevention (eg, Early symptoms after stopping opioids, barbiturates, or benzodiazepines include nausea, restlessness, anxiety, and poor sleep. In addition, stopping any kind of analgesic can cause an increase in the frequency, duration, and/or intensity of headaches. These symptoms may last a few days or up to 4 weeks. Arescue medicationis used to treat withdrawal headache; rescue medications are the same as transitional medications. Transitional (bridge) medicationsare used to help prevent withdrawal headache symptoms if withdrawal of the overused medication, use of the rescue medication, and preventive medications are unlikely to be successful. Transitional medications include NSAIDs Corticosteroids Dihydroergotamine Prochlorperazine Clonidine(preferred if the overused medication was an opioid) Phenobarbital(used to prevent withdrawal seizures if the overused medication was a barbiturate) After medication overuse headache has been treated, patients should be instructed to limit acute use of all headache medications as follows: For NSAIDs: < 6 days/month For triptans,ergotamine, or combination analgesics: < 4 days/month Use of previously overused medications is discouraged. Cognitive therapy, biofeedback (eg, frontal electromyographic biofeedback), and education are helpful. 