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?
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.
mztorontopainmd
7 July 2016 @ 8:36 pm
@migraine_blog It’s real but most important question: what’s causing the headaches in the first place? …
mztorontopainmd
7 July 2016 @ 8:38 pm
@migraine_blog Most don’t take analgesics/triptans for no reason. MOH always the icing, almost never the cake
9 July 2016 @ 2:08 am
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.
23 May 2018 @ 11:37 am
I have a question: Can you have serious side effects from too much Rizatriptan?
I have been having migraines for over 10 years now. I have tried all the meds i.e. anti-depressants, Topamax, blood pressure meds, etc., all that have been talked about, but to no avail except Rizatriptan.
Also have used essential oil approaches, magnesium supplements, hyperbaric oxygen therapy $6000.00 (rip-off)…nothing.
The migraines have increased to a daily occurrence, once in a while have a day or two reprieve, (used to be a week but not anymore). I have started cutting the tabs in half with just as much success because of the cost $167 per 12, since we have no drug plan/coverage.
I am seeing an internist in a week for fainting, which has occurred 3 times in 2 years. The last time I was in the company of an RN and she said it looked like a seizure. Could the migraine be at the root of the fainting or too much medication? I guess I need to wait for the professional answer, but I’m in Ontario Canada, and the care here really has gone downhill.
Maybe you could suggest questions to ask the internist?? I don’t know, but I haven’t felt well for many years now and can’t seem to get any answers. Blood work fine, heart, fine, bit of arthritis in neck (but it’s killing me) I have become isolated, no one wants to be around a sick person, not at all, and getting out seems to be limited to groceries, and a bit of other shopping/dr. appts. Plus, I have been under fairly extreme stress due to family, husband situations.
Thanks in advance for any help, advice you can give or point me to. I really do appreciate your work and your blog.
Thank you James. … ~ Carol Halford
18 September 2018 @ 2:40 pm
Carol Halford – have you tried Sumatriptan? The reason I am asking is because I was able to use a coupon from GoodRx.com at my local pharmacy and get 63 100mg tablets for about $50. That’s the only way I can afford triptans. The other triptans are on their too, but at different (and higher) prices. You should check them out 🙂
25 September 2018 @ 9:17 am
Patty Doherty – thank you for your suggestion. I checked out the GoodRX site, but because we live in Canada, this is not available to me. Since I will be turning 65 in November, there are some government programs that may give some relief for the cost of this. We shall see, hopefully it may be reduced. Thank you for commenting, much appreciated!!