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medication-overuse headache

Medication-Overuse Headache and the Brain (new study)

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It has been estimated that half of the patients with chronic headache types have medication-overuse headache.  If you’re taking abortive medication for more than 10 days each month, you may have medication-overuse headache (commonly called rebound headache).

Medication-overuse Headache - what are the dangers?

MOH could be a result of abortive medications such as triptans, paracetamol / acetaminophen, ibuprofen, and many others.  The good news is that most patients seem to improve once they stop taking the medication.  They also tend to respond better to preventative medications.

The bad news is that some patients do not improve – a significant number.  Has the medication overuse done permanent damage to the brain?

A study in Switzerland, published last month, investigated grey matter changes in the brain to see if there was a difference among patients who did improve and who didn’t.

Changes in grey matter related to chronic pain are well known.  But could these changes predict how well a patient will respond to treatment?

These researchers believe so.  The evidence demonstrated that there were indeed differences between patients who improved and patients who did not.  A lot of the difference could be seen in the orbitofrontal cortex area of the brain.

The orbitofrontal cortex is one of the least-understood areas of the brain, but it does seem to relate to decision-making, mood, and social interactions.

This study is another reminder of how important it is to get proper ongoing treatment.  It also shows again that every patient is different.  It may give us clues about how well certain patients will respond to certain treatments, and how headache conditions and other chronic pain conditions impact the brain physically.

References:

Status Migrainosus – when the attack doesn’t stop (graphic)

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Status Migrainosus

A person with migraine without aura
has a severe debilitating migraine attack
which lasts longer than 3 days.
Even after temporary relief from medication,
the symptoms remain.


Misdiagnosis is frequent. You may have…

Always see a doctor if symptoms change
or are worse than ever.

Your doctor may recommend:

A few more resources:

Chronic Tension-Type Headache and Chronic Migraine: Profiles

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Profiling is so dangerous, isn’t it?  I mean, seriously.  As soon as you say something like “most migraineurs are women”, you’re leaving out huge numbers of us who ain’t.  Or if you say “migraineurs tend to be fat” you beg all kinds of questions – is it due to the medication they’re taking?  The time they spend in bed?  Is obesity a migraine trigger?  Are we “blaming” people who are overweight?  Did I just use the “f-word” in this post??

Smoking and chronic migraine?

Sure, profiles are interesting.  Maybe they allow us to focus more on women instead of men, since they have more migraine attacks.  Wait!  I don’t like that idea either.  We all need help, and we’re all very different!

But these types of generalities can be useful – as long as we’re careful with them.  They can point to tendencies.  To possible biological realities of migraine disease.  And to possible treatments.

But don’t tell me migraineurs are all depressed, or all women, or all f … frugal… or whatever.

This is actually more of a comparison than a profile.  What’s the difference between those with chronic tension-type headache and those with chronic migraine – from The Journal of Headache and Pain.

Chronic TTH Chronic Migraine
Less common More common
Less likely to be female More likely to be female
More likely to drink alcohol Less likely to drink alcohol
Less likely to smoke More likely to smoke
Less likely to be obese More likely to be obese
Less likely to report frequent acute pain drug use More likely to report frequent acute pain drug use
More likely to be low educated Less likely to be low educated

This study may be even more useful in understanding chronic tension-type headache.  After all, a lot of the right column is pretty well known.  This is particularly true for weight issues (a struggle for migraineurs due to medication, and also a very possible factor in developing chronic migraine) and pain drug use (medication overuse is a HUGE factor when it comes to chronic migraine).

Could alcohol use influence chronic tension-type headache?  Or lifestyle issues related to a lower education?

But one of the problems with a study like this is that many people seem to have both conditions.  And there is increasing evidence that both conditions are related.

Do you suffer from chronic tension-type headache?  Have you found a direct link with alcohol consumption in particular?  Or, as a migraineur, have you found weight loss to be a help?  Or quitting smoking?

For more details:  Epidemiological profiles of patients with chronic migraine and chronic tension-type headache.

What is Transformed Migraine?

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Transformed Migraine is another older term that isn’t used as often anymore.  What used to be called transformed migraine or evolutive migraine can now actually be called several different things, depending on the diagnosis.

The most basic diagnosis is chronic migraine.  Transformed migraine (TM) referred to patients who had migraine symptoms very frequently or even every day.  That’s what chronic migraine is.

In chronic migraine, the patient has migraine symptoms at least 15 days per month for at least 3 months.

Cases of chronic migraine often start out as something else – simple migraine without aura most often.  (Hence the term "transformed")

Now, the diagnosis does get a little tricky here.  First of all, you could also have chronic tension-type headache if your symptoms more closely mirror the technical description of tension-type headache.  However, you could even have both at the same time.  And just how different tension-type headache and migraine are biologically is a matter of debate.

If your doctor thinks you may have transformed migraine or chronic migraine, there are certain things she’ll want to check out.  First, she’ll want to do a work-up to make sure there isn’t another cause for your symptoms.  This includes other diseases, or a recent trauma to the head, for example.

She’ll also want to see what medication you’re taking – how much, and how often.  She may diagnose you with medication-overuse headache if she feels cutting back on medication will help you.

You may also be diagnosed with probably chronic migraine if there’s a chance that medication overuse has played a role in the past couple of months.

She’ll also want to check and see what may be aggregating your condition – migraine triggers, biological factors, and so on.  She’ll also want to check for related conditions, such as depression.

Treatment for chronic migraine can be challenging, but many people have found relief.  Your doctor will probably focus more on preventative strategies, such as supplements, preventative medications, and lifestyle changes.  These things can improve your quality of life over the long term.

More on transformed migraine from the National Headache Foundation.

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The articles on Headache and Migraine News are © 2004-2026 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.