Article

Medication-overuse headache: similarities with drug addiction.

Clinica Neurologica, Dipartimento di Neuroscienze, Università Tor Vergata, Rome, Italy.
Trends in Pharmacological Sciences (Impact Factor: 9.99). 03/2005; 26(2):62-8. DOI: 10.1016/j.tips.2004.12.008
Source: PubMed

ABSTRACT Medication-overuse headache (MOH) is a clinically important entity and it is now well documented that the regular use of acute symptomatic medication by people with migraine or tension-type headache increases the risk of aggravation of the primary headache. MOH is one the most common causes of chronic migraine-like syndrome. In this article, we analyse the possible mechanisms that underlie sensitization in MOH by comparing these mechanisms with those reported for other forms of drug addiction. Moreover, the evidence for cognitive impulsivity in drug overuse in headache and in other forms of addiction associated with dysfunction of the frontostriatal system will be discussed. An integrative hypothesis for compulsive reward-seeking in MOH will be presented.

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    ABSTRACT: Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1%-2%. It is a severe form of headache where the patients often have a long history of headache and of unsuccessful treatments. MOH is characterized by chronic headache and overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This review focuses on aspects of epidemiology, diagnosis, pathogenesis, prevention, and treatment of MOH. We suggest that information and education about the risk of MOH is important since the condition is preventable. Most patients experience reduction of headache days and intensity after successful treatment. The first step in the treatment of MOH should be carried out in primary care and focus primarily on withdrawal, leaving prophylactic medication to those who do not manage primary detoxification. For most patients, a general practitioner can perform the follow-up after detoxification. More complicated cases should be referred to neurologists and headache clinics. Patients suffering with MOH have much to gain by an earlier treatment-focused approach, since the condition is both preventable and treatable.
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    ABSTRACT: We investigated whether polymorphisms of the endothelial nitric oxide synthase (eNOS), neuronal NOS (nNOS), and GTP cyclohydrolase I (GTPCH) genes are involved in the aggravation of migraine induced by overuse of medications. We studied 47 patients with migraine (six males and 41 females; 36.4 ± 10.3 years of age) and 22 patients with migraine exhibiting medication overuse headache (MOH, one male and 21 females; 39.6 ± 9.9 years of age). The genotypes of polymorphisms of the eNOS (rs1799983), nNOS (rs2682826), and GTPCH (rs841) genes were analyzed using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. The genotypic distributions of rs2682826 (T/T plus T/C vs. C/C, P = 0.254), rs1799983 (G/G vs. G/T plus T/T, P = 1.000), and rs841 (T/T plus T/C vs. C/C, P = 0.149) were not significantly different between patients with migraine and patients with MOH. The results of this study showed an absence of association between the polymorphisms of eNOS, nNOS, and GTPCH genes and the complication of MOH in patients with migraine.
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    ABSTRACT: Background Both medication-overuse headache (MOH) and drug dependence share similar clinical features and the latter displays some deficits in visuospatial attention. The line bisection performance might help to indicate whether there is also a disruption in the visuospatial attention in MOH. Methods We administered the line bisection test and measured anxiety and depression levels in 21 patients with MOH, 26 patients with chronic tension-type headaches (CTTH) and in 22 healthy volunteers. Results On average, MOH patients significantly bisected leftward when referring to both frequency and magnitude, whereas the healthy volunteers and CTTH patients bisected slightly rightward. The levels of anxiety and depression were elevated in both MOH and CTTH patients compared to healthy volunteers, but the anxiety / depression levels were not correlated with the line bisection errors in all participants. Conclusions We found a pronounced pseudoneglect in MOH, which might indicate a relatively hyperactive right or hypoactive left hemisphere, or both, suggesting the disorder’s neuropsychological mechanism might overlap with that of drug dependence.
    Translational Neuroscience. 06/2014; 5(2):117-122.

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