Medication overuse headache: Etiology, clinical features, and diagnosis
- Ivan Garza, MD
Ivan Garza, MD
- Assistant Professor of Neurology
- Mayo Clinic College of Medicine
- Todd J Schwedt, MD, MSCI
Todd J Schwedt, MD, MSCI
- Associate Professor
- Department of Neurology
- Mayo Clinic
Chronic daily headache is a descriptive term that encompasses several different specific headache diagnoses. Chronic daily headache types of long duration (ie, four hours or more) include chronic migraine, chronic tension-type headache, hemicrania continua, and new daily persistent headache. Medication overuse headache (MOH), a secondary headache disorder, frequently complicates management of multiple primary headache disorders. (See "Overview of chronic daily headache".)
This topic will review the etiology, clinical features, and diagnosis of MOH. The treatment and prognosis of MOH is discussed separately. (See "Medication overuse headache: Treatment and prognosis".)
Medication overuse headache (MOH) is the term applied to headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute or symptomatic headache medication for more than 3 months. It usually, but not invariably, resolves after the overuse is stopped . MOH has also been termed analgesic rebound headache, drug-induced headache, and medication-misuse headache.
Although not a primary type of chronic daily headache, MOH deserves proper coverage since it frequently coexists with primary chronic daily headache. In some cases, MOH may be associated with the development or maintenance of a chronic daily headache syndrome .
Available evidence suggests all drugs used for the acute symptomatic treatment of headache can cause medication overuse headache (MOH) in primary headache disorders [3,4]. The precise mechanisms that lead to MOH are still uncertain. However, multiple factors seem to play a role, including genetic predisposition, central sensitization, and biobehavioral factors.
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