However, the entity “medication overuse headache” (MOH), as deﬁned in the article, is misleading and inaccurate. Current diagnostic criteria for MOH only require abortive medication use on 10 or 15 days/month (depending upon the drug).2 What is not needed is any evidence that the abortive actually causes an increase in headache. Medication overuse (MO) often occurs among people with frequent headaches. However, MO does notnecessarily lead to increased headache.Diagnosing MOH is not an easy task. MOH diagnosis must require an individu-alized assessment of the patient’s medication and headache history.The epidemiologic studies of MOH are not valid,as they do not differentiate MO from MOH.
A number of years ago, all abortives, including non-steroidal anti-inﬂammatories (NSAIDs), were implicated in MOH. We now realize that certain drugs (NSAIDs and triptans) are less likely to cause MOH than others. Opioids and butalbital compounds are the worst offenders.Although simple NSAIDs usually do not contrib-ute to MOH, they continue to be included in the MOH criteria.
Patients often are given the label of MOH simply because they admit to regularly consuming over-the-counter analgesics or a triptan. Many patients who fre-quently use these medications do not suffer from MOH. There are a number of variables, including genetics, age, type of drug, and so on, that help to explain why one patient suffers from MOH, whereas the next patient does not.
For many patients with frequent headaches,behavioral techniques and preventive medications (including Botox) are inadequate.Our current preventives often provide little relief and frequently cause unacceptable side effects.We do not have any preventives that were initially developed for headache. One long-term study indicated that only about half of migraineurs found any preventive helpful for longer than 6 months.3,4 Declining efﬁcacy and increased side effects often lead to discontinuation of the preventive. Many physicians are quick to blame the patient for causing
MOH. The patients are told that they are suffering from MOH because of a particular medication, even though (1) they have only been taking that drug for a short time,(2) the headaches did not increase once they began the medication, or (3) drug withdrawal did not lead to a lessening of the headaches.
Physicians often instruct the patient to only use the abortive 2 days/week.The patient usually responds,“that is ﬁne, but what do I do the other 5 days? I have to function.” Many headache specialists and neurologists maintain a rigid posture, refusing to allow more than a bare minimum of abortive medication. The patient either suffers or drifts elsewhere
Much of what is written about MO and MOH is con-fusing, with little basis in fact. These are arbitrary terms without scientiﬁc validation.Of course we must try to mini-mize abortives. Patients on frequent abortive medication should be withdrawn for a period of time, which is easier said than done. However, many refractory patients would have zero quality of life without their (frequently used) abortives.
The current criteria conﬂates MO with MOH. As a result,MOH is wildly overdiagnosed.An inaccurate label of MOH may harm the patient. Patients with the MOH diag-nosis often are denied the only medication that is helpful. We could redeﬁne MOH using scientiﬁcally validated criteria. Alternatively, we could drop the term MOH altogether.
I think a lot of people with chronic migraines have been waiting for This to come out for some time. Given they have been told they are in rebound if they use more than 9 triptans a month. More than 9 NSAIDs a month. No more than two a week of triptans… or rebound! Apparently we all rebound at the drop of a hat… which We know is Not true, so how can they not know this fact. We know some medications are fine and some not fine. We know some cause problems and some do not. It is a touchy subject with us for a reason because neuos use this like crazy to get us off medications, we need to function, when we were not rebounding to begin with.