protective against developing chronic headaches. However, using these drugs more often (> 10 days per month)
increased the risk. Of more interest was that combining
the NSAIDs with triptans did not increase the risk than
when taking triptans alone.
General Guidelines to Avoid MOH
To avoid MOH and to reduce the risk of developing
chronic migraine from occasional headaches, follow these
five easy steps:
1. On a weekly basis, track how many days you
take any medication for a headache, even if it is
only over-the-counter (OTC) medications. Many
patients find they take more medication than they
believed. You may even have to estimate based on
how quickly you fill a prescription or buy a new
bottle at the store. Ask yourself, how long does a
bottle of 100 aspirin, acetaminophen, or ibuprofen
last?
2. Avoid using butalbital or opioid-containing medications. Only use them as second-line medications
(after the first medication you take does not work).
These drugs should never be used more than 4 days
per month.
3. Use OTC analgesics (NSAIDs, acetaminophen)
as your first choice but limit their use to 10 days
per month or less as they may actually reduce the
number of headache days per month. Newer prescription NSAIDS, such as diclofenac potassium
(Cambia) for oral solution,which can be taken
alone or with a triptan. This drug can be effective,
even when you are nauseous
4. If the OTC NSAIDs are not effective, then a
triptan such as sumatriptan (Imitrex)may be added
as this combination has the least risk of developing
MOH or chronic migraine. Some triptans are
longer lasting and therefore may have a preventative effect as well. These agents include frovatriptan
(Frova) and naratriptan (Amerge).
5. If the first four options are not effective, consulting
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a physician specializing in headache medicine is
warranted. A headache specialist is experienced
in the nuances of headache management, such as
adding a preventative daily medication and reducing your headache triggers. The headache specialist
may suggest other alternative treatments (such
as biofeedback) that can be used to reduce the
number of headaches and those days that require
medication.
The problem of MOH is not limited to adults. Children
and especially adolescents are at risk as well.
How Do You Manage Medication Overuse
Headaches?
For one, reading this article can be a treatment step.
Several studies have shown that recognizing the problem,
and reducing or stopping the responsible drug can be
successful in a significant number of patients. This can be
especially effective if this is the first attempt at stopping
the drug. If the drugs contain butalbital or opioids, you
should consult your physician prior to stopping these
agents as withdrawal symptoms, which may be severe,
can occur.
If you cannot stop the drug or drugs without experiencing worse headaches, then your headache specialist may
suggest alternative therapies. In some cases, admission
to a specialized headache unit in the hospital may be
necessary to stop the offending drug.
Although there are few studies on this group of patients,
as many as 30 to 60 percent of patients presenting to
headache specialty clinics may be experiencing MOH.
Finally, remember that our understanding and treatment of headaches is still an ever developing field. We
have presented general guidelines to help you avoid
worsening your headaches. The most important tool
is an appropriate diagnosis and thorough physical and
neurological evaluation. Once the correct diagnosis is
established, appropriate therapy can be selected. The goal
is to prevent the headaches, and not just treat the acute
symptoms. HW
2014
3/4/14 8:11 PM