Friday February 10, 2023 – Author: zdr
Patients with chronic headaches need painkillers. Absurdly, taking them can make the problem worse. “Painkiller overuse” is common and easily treatable – but even many doctors don’t seem to have it on their radar screens.
Pain is usually your body’s alarm signal that something is wrong. But some pain is there, although organically everything is in order. Because they are then the problem themselves, one speaks of “primary” headaches – in contrast to the “secondary” headaches, which are merely the result or expression of another primary illness. Well-known examples of such “primary” headaches are migraines or tension headaches.
Unusual clinical picture: “drug overuse headache” (MOH)
Medication overuse headache (MOH) can develop as a result in people who frequently take painkillers for recurring primary headaches. “Although the disease can be both treated and prevented, the prevalence (= disease frequency) of MOH is high worldwide,” says a statement by the German Neurological Society (DGN). Many of those affected and even many of the doctors treating them simply did not have this clinical picture on their radar.
MOH (from English: medication overuse headache) is an independent headache disorder whose pathophysiological mechanisms have not been fully clarified. Discussed in science: a disturbed pain modulation, central sensitization, psychological and behavioral as well as genetic factors.
How is a drug headache diagnosed?
“For the diagnosis of MOH, the connection between the too frequent intake of acute headache medication and chronification of the headache must first be elucidated,” says the specialist association DGN. This is done on the basis of anamnesis (those affected are recommended to keep a headache diary) and neurological examination.
When does one speak of a MOH with illness value? If those affected with pre-existing primary headaches experience headaches that are treated with painkillers or migraine medications on at least 15 days per month – and this for more than three months, according to the DGN.
Medication headache: Particularly common with triptans
The development of an overuse headache depends, among other things, on the type of painkiller taken. Those who take triptans (the most modern medication for migraines) can get these headaches more often or faster than someone who takes ibuprofen, for example. Ibuprofen is a “nonsteroidal anti-inflammatory drug” (NSAID) that is used to treat pain and rheumatism. The German Society for Neurology classifies painkillers containing opiates as “particularly problematic” – because of the additional potential for dependency.
Other risk factors for overuse headache
According to the DGN, other risk factors for drug overuse headache are:
- female gender
- low educational or social status
- additional psychiatric disorders such as depression or anxiety disorders
- dependent behavior (for example)
- Taking medication for insomnia or tranquilizers.
The DGN expressly encourages pain patients to speak openly to their doctor if they suspect overuse headaches. “It is important that the patients are not ‘blamed’ for the situation,” says Hans-Christoph Diener, lead author of the DGN guideline on this clinical picture. The problem usually lies in inadequate headache or migraine management and not in drug abuse. MOH primarily occurs when there is insufficient prophylaxis for primary headache disorders.
How is overuse headache treated?
“Once MOH has been diagnosed, appropriate treatment according to current guidelines can usually effectively reduce the headache or disease burden and the consumption of painkillers,” says the DGN. The success rate is about 50 to 70 percent after 6 to 12 months, says Diener, who is considered one of the leading neurologists in Germany.
The treatment of MOH consists of reducing the frequency of taking the overused acute painkillers or stopping them completely. At the same time, suitable headache prevention (e.g. with topiramate, amitriptyline, botulinum toxin) or antibody therapy against the migraine-triggering neuropeptide is started. Depending on the situation, this can be done on an outpatient basis, in a day clinic or as part of inpatient hospital treatment.