What Is A Medication Overuse Headache And How Is It Treated?

A complication that comes with trying to treat migraines is the wide variety of potential causes, some of which require the expertise of neurology specialists to diagnose and treat.

Whilst migraines typically cannot be cured outside of specific cases where compressed nerves are the primary cause, the symptoms can often be treated and managed, sometimes even by using conventional painkillers such as paracetamol or ibuprofen.

However, one potential complication of relying on acute medications for what is often a chronic condition is the development of medication overuse headache (MOH), a condition that can cause already painful migraines to temporarily feel even worse.

What is a medication overuse headache? How common is it? Which medicines cause it and in which doses? And what treatments are available to help ease your migraines if medication makes them worse?

What Is A Medication Overuse Headache?

A medication overuse headache is a headache that develops or gets worse after taking medication frequently on a regular basis without breaks to allow it to completely pass through the system.

It is a subset of a chronic headache disorder, such as migraines or tension headaches, and they tend to feel the same as your migraines, but can be significantly more painful or can feel almost constant.

They are often known as rebound headaches, as they often cause vicious chains of headaches where medication is taken to treat a migraine, which causes another migraine that you will often take medication for.

It is often worse first thing in the morning or following exercise, but can sometimes be a constant dull ache that has spikes of pain as well.

How Common Are Medication Overuse Headaches?

Medication overuse headaches typically affect around one in 100 people, which, whilst not common, is also not exactly rare. It tends to occur more commonly with people who get daily migraines rather than episodic ones.

In some cases it can cause the transformation due to a chain of taking medications for migraines caused by taking medications.

One complication in diagnosing MOH is that a neurologist can only confirm that a particular pattern of migraines is medication overuse headaches after they have stopped.

Which Medications Cause Overuse Headaches?

Medication overuse headaches tend to occur when you take any acute medication for your migraine on a regular, long-term basis.

Whilst the exact timings can vary, as can the effects, if you feel your migraines are intensifying or becoming more common and you take certain medications at least twice a week for three months, MOH could be the cause.

The main medications that cause MOH are those typically taken or prescribed for migraines that work for the majority of people who get migraines. These include:

• Opiates, particularly codeine on its own as well as co-codamol, are amongst the most common causes of MOH.
• Triptans, which whilst not painkillers, can still cause MOH.
• Ergotamine, a rarely used medicine used to treat migraines.
• Painkillers, including both paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin.

Some people are more sensitive to MOH than others, but the general advice is to try to avoid taking painkillers for migraines for more than a couple of days at a time.

Curiously, the same medications can be used to treat other chronic pain disorders, such as arthritis, without causing overuse headaches, for reasons that are still the subject of research.

How Are Medication Overuse Headaches Treated?

There are two steps to treating medication overuse headaches:

• Stop taking the medications that are causing the overuse headaches.
• Use alternative preventative treatments and medications to treat migraines.

Both parts of this treatment plan should be navigated carefully with the help of a neurologist who specialises in migraines and pain conditions, and you will often need support to get through the difficult stages of treatment.

Stopping Medications

Seek advice before stopping any medications that you are prescribed, as they can recommend the best way to stop to minimise potential side effects.

If you have been prescribed opiate painkillers or triptans, you may feel withdrawal symptoms that can temporarily make your migraine feel worse. As with discontinuing any medication, a gradual approach will likely lead to less severe withdrawal symptoms.

In some cases, hospitalisation and medical supervision are necessary to stop medications, whilst in other cases, people can simply stop taking their painkillers without withdrawal effects.

Alternative Preventative Treatments

You may be recommended preventative treatments to stop or significantly reduce the effects of migraines, but which ones are effective for you will depend on the causes of your migraine.

It is best to get in touch with a neurology specialist or neurosurgeon to see if a long-term solution is available for you.

Explore the Queen Square website to learn more about our advanced radiotherapy and neurosurgical treatments for chronic migraines and medication overuse headaches.