Medication overuse headache
Medication overuse headache is a headache caused by regularly overusing the acute medicines taken to treat headache, in someone with a pre-existing headache disorder.
Remember
Look for headache on at least 15 days a month plus overuse of acute medicine for more than 3 months: at least 15 days a month for simple painkillers, or at least 10 for triptans (drugs that treat an acute migraine attack) or opioids (stronger painkillers). Then treat it by stopping the overused drug.
Memory aid
15 and 10
Use 15 and 10 to recall the days-a-month thresholds: 15 for simple painkillers and 10 for triptans or opioids.
Medication overuse headache paradoxically arises from taking painkillers too often, most commonly to treat headaches. The painkiller itself keeps the headache cycle going. It affects women more than men, and it often comes with other problems such as depression.
The diagnosis needs headache on at least 15 days per month in someone with a pre-existing headache disorder, most often migraine. Regular medication overuse for more than 3 months is also required, with no better alternative diagnosis.
The threshold for overuse depends on the drug. For simple analgesics such as paracetamol and NSAIDs (non-steroidal anti-inflammatory drugs, which include ibuprofen), overuse means use on at least 15 days per month. For triptans (drugs that treat an acute migraine attack) and opioids (stronger painkillers), the threshold is lower, at least 10 days per month. In each case the pattern has to continue for more than 3 months.
Count days of use, rather than doses: five doses on one day is one day.
The overused medication is withdrawn with appropriate clinical support, and the underlying headache disorder is treated too. Headache may temporarily worsen once the overused drug is stopped, and improvement is not guaranteed in any set period. Opioid withdrawal requires a supervised plan. Taking a higher dose, or switching to another acute painkiller, keeps the cycle going.
Key facts
- Headache frequency
- headache on at least 15 days per month in someone with a pre-existing headache disorder.
- Simple analgesics
- paracetamol and NSAIDs such as ibuprofen count as overuse when taken on at least 15 days per month.
- Triptans or opioids
- overuse means use on at least 10 days per month.
- Duration
- the overuse pattern must continue for more than 3 months.
- What is counted
- days of use, rather than the number of doses taken on each day.
- Treatment
- stop overused simple analgesics and triptans, usually abruptly, for at least 1 month (opioid withdrawal needs a supervised plan), and warn that headache often worsens in the short term before it improves.
Exam traps
- Overuse of a simple analgesic on its own does not meet the criteria, because medication overuse headache also needs headache on at least 15 days a month; both conditions must be met.
- Headache that meets the frequency threshold still does not qualify if a triptan is used below the 10-day threshold for triptans, but it would qualify with use on at least 10 days.
- The 10-day drug threshold does not apply to simple analgesics such as paracetamol and ibuprofen, which need use on 15 or more days a month; the 10-day threshold belongs to drugs such as triptans, opioids and combination analgesics (a single tablet containing two or more painkillers).
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