Chronic Headache Due to Overuse of Analgesics and Anti-Migraine Agents

Background: The frequent or regular use of analgesics and anti-migraine drugs can make headache more frequent and induce the transformation of episodic to chronic headache. Chronic headache due to medication overuse is defined as headache that is present on >= 15 days per month for at least three months in a patient who previously suffered from primary headaches, and who takes analgesics on >= 15 days per month or anti-migraine drugs (triptans or ergot alkaloids), opioid drugs, or combined analgesics on >= 10 days per month. Methods: This review is based on pertinent articles published up to December 2017 that were retrieved by a selective search in PubMed employing the terms medication overuse AND headache and medication overuse headache. Results: The prevalence of medication overuse headache in the general population in Germany is 0.7%-1%. This disorder is more common in women and in persons suffering from comorbid mental disorders or other painful conditions. The treatment of medication overuse headache consists of three steps. Patient education and counseling are given with the goal of reducing the intake of medication for acute headache treatment. The ensuing headache prophylaxis is with topiramate, amitriptyline, or onabotulinum toxin A. If these treatment strategies fail, a drug holiday is recommended. This can be in the outpatient, day clinic, or inpatient setting, depending on the severity of the condition and its comorbidities. Conclusion: Patients who frequently take acute medication to treat headache episodes must be identified early in order to avoid headache chronification and medication overuse headache. The suggested treatment algorithm is still in need of validation by randomized trials.