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Medication overuse headache

Last reviewed: 5 Oct 2024
Last updated: 12 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • underlying primary headache disorder
  • headache on ≥15 days per month
  • overuse of acute headache medication for >3 months
Full details

Other diagnostic factors

  • normal neurological examination
  • absence of red flag symptoms and/or signs
Full details

Risk factors

  • migraine as the underlying primary headache disorder
  • female sex
  • use of opioid, barbiturate, triptan, or ergot derivative
  • anxiety and/or depression
  • chronic musculoskeletal disease
  • chronic gastrointestinal disease
  • low-level education
Full details

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
Full details

Investigations to consider

  • MRI brain
  • CT brain
  • CRP/erythrocyte sedimentation rate (ESR)
  • lumbar puncture (LP)
  • cerebrospinal fluid (CSF) culture
Full details

Treatment algorithm

ACUTE

adults: uncomplicated

adults: complex

children and adolescents

Contributors

Authors

Sait Ashina, MD, FAHS

Director

BIDMC Comprehensive Headache Center

Beth Israel Deaconess Medical Center

Assistant Professor of Neurology and Anesthesia

Department of Neurology and Anesthesia

Critical Care and Pain Medicine

Harvard Medical School

Boston

MA

Disclosures

SA declares that he has received fees for consulting from Allergan, AbbVie, Eli Lilly, Impel NeuroPharma, Linpharma, Lundbeck, Satsuma, and Theranica. He has received fees for teaching from Eli Lilly and Teva. He has received unrestricted research grants from AbbVie, Eli Lilly, and NINDS, paid to his hospital/institution. SA also serves as Associate Editor for the journals Neurology Reviews, Frontiers in Neurology, and BMC Neurology, and is an advisory board member for the Journal of Headache.

Hsiangkuo Yuan, MD, PhD

Associate Professor of Neurology

Department of Neurology

Director of Clinical Research

Jefferson Headache Center

Thomas Jefferson University

Philadelphia

PA

Disclosures

HY declares that he has received a grant from the National Institutes of Health (reference R44NS115460). He has served as a site investigator for Teva, AbbVie, Trillen, and Thermaquil. He has also served on advisory boards or as a consultant for Silva, Clexio Biosciences, and Pfizer.

Peer reviewers

Benjamin Wakerley, ​FRCP, PhD

Consultant Neurologist

Headache Lead

University Hospital Birmingham NHS Foundation Trust

Honorary Clinical Associate Professor

University of Birmingham

Birmingham

UK

Disclosures

BW declares that he has received speaking fees from AbbVie. He is the founder of Ceftronics Ltd and a creator of the CEFREF headache app.

Alyssa Ann LeBel, MD

Director

Chronic Headache Program

Boston Children's Hospital

Associate Professor of Anesthesia

Harvard Medical School

Boston

MA

Disclosures

AAL declares that she has no competing interests.

  • Differentials

    • Chronic primary headache disorder
    • Idiopathic intracranial hypertension (pseudotumor cerebri)
    • Spontaneous intracranial hypotension and/or cerebrospinal fluid (CSF) leak
    More Differentials
  • Guidelines

    • European Academy of Neurology guideline on the management of medication-overuse headache
    • International classification of headache disorders, 3rd edition
    More Guidelines
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