brain, spinal cord, and nerve disorders
Medication Overuse Headache
Treatment of Medication Overuse Headache
A different medication to prevent the original headache (usually a migraine) Withdrawal of the overused headache medication Use of a different type of headache medication (called a transitional medication) to manage withdrawal symptoms that occur after stopping the drug Biofeedback and cognitive techniques Usually, doctors first give the person a preventive medication to treat the original headache disorder. The overused medication is stopped later, often abruptly. However, if people are taking high doses of opioids, barbiturates, or benzodiazepines, the amount of the overused medication is gradually decreased, over 2 to 4 weeks. Sometimes people can be treated as outpatients when the medication is stopped. However, people with headache due to opioid overuse are hospitalized. Stopping these medications more abruptly can cause symptoms such as nausea, restlessness, anxiety, and poor sleep. Stopping any kind of pain reliever can cause headaches to occur more often, last longer, and become more intense. Symptoms after stopping a medication may last a few days or up to 4 weeks. Atransitional medicationis used to treat headaches that occur after stopping the overused medication. Transitional (bridge) medications are used to help prevent headache symptoms of withdrawal if stopping the overused medication causes too many, sometimes dangerous symptoms The transitional drug should be a different type of headache medication from the one that caused the overuse headache. Doctors limit use of transitional medications to less than twice a week if possible. Transitional drugs (see table Some Drugs Used to Treat Migraines ) include the following: NSAIDs A corticosteroid Dihydroergotamine Prochlorperazine, anddiphenhydramine Clonidine(to relieve symptoms due to withdrawal when the overused medication was an opioid) Phenobarbital(used to prevent withdrawal seizures when the overused medication was a barbiturate) After medication overuse disorder has been treated, people are instructed to limit their use of all rescue and transitional headache medications used to stop (abort) headaches as follows: For NSAIDs, to fewer than 6 days a month For triptans,ergotamine, or combinations of headache medications, to fewer than 4 days a month Medications used to prevent headaches should be continued as prescribed. Doctors encourage people to keep a headache diary. In it, people write down the number and timing of attacks, possible triggers, and their response to treatment. With this information, triggers may be identified and eliminated when possible. Then, people can participate in their treatment by avoiding triggers, and doctors can better plan and adjust treatment. Biofeedback None People are counseled to avoid using previously overused medications. They are also taught and encouraged to adopt healthy lifestyle habits. 