2. Definition
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MOH (Medication-Overuse headache)
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Secondary chronic daily headache
Headache induced by the overuse of analgesics,
triptans or other acute headache compounds,
ocurring 15 days/month, 4hrs/day, per 3 months or
more.
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Repeated medication reaches a threshold causing
transformation (chronification)
3. Introduction / Epidemiology
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Higher preponderance in woman
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In a study on episodic migraineurs (n=532), the 1-year
incidence of chronic headache was 14%, with a higher
risk for patients who had a higher headache frequency at
baseline and for patients taking greater amounts of
analgesics.
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Ergotamine, analgesics, barbiturates and caffeine
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Poorer quality of life (Measured by scales: higher score
on MIDAS: Migraine disability assessment scale)
4. Clinical manifestations
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Criteria established by the International Headache
Society (IHS) in 2005
The primary headache disorder leading to MOH is
migraine in most cases.
MOH mainly occurs in patients with a primary headache
disorder
Comorbidities
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Subclinical obsessive-compulsive disorder
Anxiety - Mood disorders
Type of medications overused.
5. Symptoms
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Circadian periodicity
ď¨ Patients
may be awakened from sleep or have onset
upon arising
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Neck pain / Cervicogenic pain.
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Rhinorrhea, nasal stuffiness, postnasal drip, and
ocular or gastrointestinal symptoms, likely
caused by withdrawal and most evident in opioid
rebound.
Nonrestorative sleep disturbance
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8. Diagnostic criteria
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There is no certainty whether combined drugs are more
likely to cause MOH or not, compared to single
substances.
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The headache features of MOH caused by ergotamine
derivatives are more severe than those caused by
triptans.
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Overuse of ergotamine + analgesics: daily tension-type-like
headache,
Overuse of triptans: (daily) migraine-like headache or an
increase in migraine frequency
9. Withdrawal treatment
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Detoxification process
ď¨ Improve
responsiveness to acute and prophylactic
drugs
ď¨ Abrupt discontinuation vs. tapered withdrawal
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Main symptoms of withdrawal
ď¨ worsening
of the headache
ď¨ nausea, vomiting
ď¨ arterial hypotension, tachycardia
ď¨ sleep disturbances
ď¨ restlessness, anxiety, nervousness
10. Withdrawal treatment
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Inpatient vs. Outpatient
ď¨ Overuse
of opioids, barbiturates, or benzodiazepines
ď¨ psychological problems
ď¨ severe medical comorbidities
ď¨ severe withdrawal
ď¨ symptoms (eg, vomiting and status migrainous)
ď¨ previous medication withdrawal failure