Medication overuse headache: A focus on analgesics, ergot alkaloids and triptans

Department of Neurology, University Hospital Essen, Germany.
Drug Safety (Impact Factor: 2.82). 02/2001; 24(12):921-7.
Source: PubMed


Medication overuse headache (MOH, formerly known as drug-induced headache) is a well known disorder following the frequent use of analgesics or any other antiheadache drug including serotonin 5-HT(1B/D) agonists (triptans). Recent studies suggest clinical features of MOH depend on the substance class that has been overused. The delay between the frequent intake of any antiheadache drug and daily headache is shortest for triptans (mean 1.7 years), longer for ergot alkaloids (mean 2.7 years) and longest for analgesics (mean 4.9 years). Treatment includes withdrawal followed by structured acute therapy and initiation of specific prophylactic treatment for the underlying primary headache. The relapse rate within 6 months after successful withdrawal is about 30% and increases steadily up to 50% after 5 years.

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    ABSTRACT: Background: Medication-overuse headache (MOH) has been defined newly by the Classification Com- mittee of the International Headache Society in 2003. We hypothesized that MOH has different clinical and psychologic features from any other chronic headaches and control group. The authors investigated the clinical and psychologic features of MOH sufferers diagnosed by newly defined criteria. Methods: Using our MOH protocol and Minnesota Multiphasic Personality Inventory (MMPI), we investigated the clinical and psychologic features of 25 patients with MOH, 23 patients with chronic head- aches, and 21 control subjects. Results: The mean age of MOH patients was 50 years and female was predominantly affected. The locations, characteristics, severity, and common accompanying symptoms of MOH were various. All patients took analgesics. The mean frequency of medication was 21 days per month and duration of medi- cation was about 8.5 years. MOH patients and chronic headache patients had higher MMPI profiles than control group in F (Infrequency), Hs (Hypochondriasis), D (Depression), Hy (Hysteria), Pd (Psychopathic Deviate), Pa (Paranoia), Pt (Psychasthenia), Sc (Schizophrenia) scales. But there was no significant diffe- rence of MMPI profiles between MOH patients and another chronic headache patients. Conclusions: The clinical features of MOH in this study were similar to previous studies. The psycho- logic features of MOH were not different from those of chronic headache. MOH sufferers may be recom- mended individual psychologic supports as chronic headache sufferers. Korean Journal of Headache 6(2):129-136, 2005
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    ABSTRACT: The overuse of acute medications in patients who are headache-prone poses a great challenge to headache management. Medication overuse-induced headache represents one of the most common iatrogenic disorders. It is the reason that most patients visit headache subspecialty clinics worldwide and often is the cause of an intractable or worsening headache in primary headache sufferers. The recent development of acute headache medications, especially the triptans, has provided increased migraine relief; however, the incidence of triptan-overuse headache has also increased. Awareness of medication overuse-induced headache and familiarity with the diagnosis and the treatment of this disorder are important to physicians who treat patients with headache.
    No preview · Article · Jul 2002 · Current Pain and Headache Reports
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    ABSTRACT: Austria is one of the countries, in which ergots are still the most commonly used acute anti-migraine drugs. Overuse and chronification is a clinical problem for ergots, but also for the recently developed triptans. In a retrospective study for the year 1999 we evaluated clinical data from all Austrian neurological hospitals including cost of withdrawal as well as the estimated cost for ergots and triptans on the pharmaceutical retail market. We identified a total of 96 patients that underwent withdrawal, all of whom because of ergot overuse, and some with considerable long-term side-effects. The cost of withdrawal (more than 1300 000) together with direct cost of medication amounted to more than 11 million. In contrast, cost of medication for triptans was 12.8 million for the same year, without any cost for withdrawal. If only cost aspects were to be considered in the prescription of acute anti-migraine drugs, our data would suggest to choose ergots rather than triptans. However, as scientific evidence is clearly in favour of triptans, decision making for the prescribing clinicians is more complex and will primarily focus on optimizing patient care, but also depend on the respective socio-economic situation.
    No preview · Article · Jan 2003 · Cephalalgia
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