Medication Overuse Headache: Overrated?

Everybody is talking about medication overuse headache (MOH). There is a big push to cut down on drugs and to find alternatives. But is it possible that we’re over-emphasizing the problem?

At last month’s meeting of the American Headache Society in San Diego, organizers set up a discussion on the topic – is MOH actually a thing?

Ok, the thesis was “Medication Overuse Headache is a Proven Entity” – true, or false?

Taking opposite sides were Dr. Richard Lipton (“true”) and Dr. Ann Scher (“false”) (two experts who have actually worked together on a number of projects in the past).

The discussion is, of course, a lot more nuanced than that. Just what is MOH? What medications can cause MOH? How much of a certain drug is too much? Are there permanent consequences to MOH? Or is it easily resolved?

Medication Overuse Headache: How big is the problem?Dr. Scher brought up an important point. Common current advice is to limit abortive medication to 2x per week or less. Medications that should especially be avoided include opioids and butalbital combination medications. So the question is – How many are being harmed vs helped by this advice?

That is the bottom line, right? Whatever the details may be, is the current focus, the current common advice, actually helping patients?

For example, is it better to take a little too much (no, we’re not talking about multiple doses per day here), or to completely quit the medication?

Few would disagree that MOH exists in some form, but there is not equal evidence for every medication.

Dr. Alexander Mauskop, who kindly reported on this discussion for us (see The existence of medication overuse headache is debated), actually advocates the use of daily triptans for a few patients. Other doctors would be horrified by the thought.

The heart of the discussion really isn’t whether or not medication overuse headache actually exists. The question is – where is it really a problem, and how can it be treated? And the truth is, we have a long way to go before we’ll have good answers to these questions. It’s good to see the discussion moving forward.

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3 comments… add one
  • Rilla Heslin Jul 9, 2016

    I’ve just had this battle with my doctor. I’m 4th generation migraineur on both sides of my family. All 4 of my kids are 5th gen, and my granddaughter is 6th gen. I’ve been fighting migraines for 60yrs, I’m 64yrs. During that last 25+ yrs, many chronic illnesses and conditions have set in, including stage 4 kidney failure, migraine induced strokes, heart problems, epilepsy, and more.
    Today the only medicines I have for my Chronic Daily and Hemiplegic Migraines, plus my other problems, are Percocet 5mg/325mg -up to 3x daily, and Stadol Nasal Spray, 1 bottle for every 3 days, and Aspirin 325mg, no more than 2x daily. I have been on these for 26 1/2 yrs. There are NO preventatives that I can take! Only Rescues, due to the fact that I’m either allergic, or can’t take the preventatives due to contraindications with my illnesses and/or medication interactions.
    It’s these or nothing. With nothing, more and worse strokes or a full heart attack will be waiting.
    I have NEVER misused them. I write down every medication I take, time and date, plus what’s going on with my health at that time. I do use holistic medicines, complimentary therapies and such before I turn to my medicines, which have only gone down in quantity, never up.
    For people like me, the Opioids and Narcotics are the only choice we have.
    One more thing, Chronic Pain Patients are NOT the ones who are to blame for ALL the drug overdoses. Overdoses from medicines and alcohol poisonings have been happening since ancient times. Since humans found that chewing on certain plants or fermented fruit or gains took away all their physical and mental control, some of them started dying from too much. Man will always find a way to “Drown” his mind and possibly kill his body. We didn’t start this and I WON’T be a Whipping Boy/Scapegoat for the medical and pharmacology communities.

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