Patient education: Medication overuse headache (The Basics)

What is medication overuse headache? — 

Medication overuse headache, or "MOH," is a problem that can happen after taking pain medicines over time to treat headaches. It usually affects people who get frequent migraine or tension headaches.

MOH is defined as a headache related to medicine use that happens on 15 or more days of each month. It usually goes away after you stop taking the medicine that caused it.

What causes MOH? — 

When a person takes pain medicine often, this can sometimes actually trigger headaches to happen more frequently over time. This is MOH. It is more likely to happen if you take medicine more than a few days a week.

Different medicines can cause MOH. They include:

●Butalbital – This is a "barbiturate" medicine. It is sometimes combined with other medicines, such as acetaminophen and caffeine, to treat severe headaches (brand name: Fioricet).

●Opioids – These are strong medicines sometimes used for short-term treatment of severe pain. They are not usually recommended for treating headaches, because they can lead to misuse or addiction. But doctors might sometimes prescribe them if other medicines do not work.

●Triptans – These are sometimes prescribed to treat severe migraine attacks. Examples include sumatriptan (sample brand names: Imitrex, Onzetra Xsail, Tosymra), zolmitriptan (brand name: Zomig), and rizatriptan (brand name: Maxalt).

Less commonly, other medicines used to treat headaches can also cause MOH if used frequently.

How is MOH treated? — 

First, your doctor or nurse will figure out which medicine is causing your MOH. This can be hard if you take more than 1 medicine for headaches.

Treatment involves:

●Stopping the medicine that caused MOH – Your doctor will talk to you about how to do this. It might involve decreasing the dose gradually or stopping all at once. In some cases, you might be able to keep taking the medicine, but at a lower dose or less often.

●Adding a different medicine to treat headaches – This can help with pain as you stop the medicine that caused MOH.

●Starting treatment to prevent future headaches – Different medicines can be used for this. Your options depend on the type of headache you get.

Can MOH be prevented? — 

Sometimes. If you get headaches often, work with your doctor. They can help you find a treatment that helps reduce the frequency of headaches. Figuring out a treatment plan that works can help prevent overuse of medicines that can cause MOH. Do not try to manage frequent headaches on your own.

Talk with your doctor about your treatment options. Some medicines are more likely than others to lead to MOH. If your doctor prescribes headache medicine, follow the instructions carefully. Limiting how often you take medicine can help lower the risk of MOH.

When should I call the doctor? — 

Call for an ambulance (in the US and Canada, call 9-1-1) if:

●Your headache starts suddenly, quickly becomes severe, or could be described as "the worst headache of your life."

●You also have a seizure, personality changes, drowsiness, or confusion, or you pass out.

●You have weakness, numbness, trouble speaking, or trouble seeing. (Migraine can sometimes cause these symptoms, but you should be seen right away the first time these symptoms happen.)

Call your doctor or nurse if:

●Your headaches are getting more frequent or severe.

●You have new headaches, especially if you are pregnant or older than 50.

●You have a fever or stiff neck with your headache.

More on this topic

Patient education: Headaches in adults (The Basics)
Patient education: Migraine in adults (The Basics)
Patient education: Tension headache (The Basics)
Patient education: Keeping track of your headaches (The Basics)

Patient education: Headache causes and diagnosis in adults (Beyond the Basics)
Patient education: Headache treatment in adults (Beyond the Basics)
Patient education: Migraine in adults (Beyond the Basics)