New headache treatment strategy needed

There is an urgent need to review current treatment strategies for the increasingly common problem of medical overuse headaches (MOH), new research indicates.

MOH, previously known as rebound headache, drug induced headache or drug misuse headache, is a headache that occurs at least 15 days a month when patients overuse medication.

Despite being very common, there are no standardised treatment guidelines for MOH. The condition is estimated to affect one in every 100 adults and one in every 200 teenagers worldwide.

“MOH is associated with severe disability, unmet treatment need and little clinical data to support current management strategies. Tolerance to the analgesic (painkilling) effect of the acute medication develops over time, consumption may increase and patients may show withdrawal symptoms when they stop the overused mediation,” explained Prof David Dodick of the Mayo Clinic College of Medicine in Arizona.

According to Prof Dodlick, in the US alone, 60% of people with chronic daily headaches attending headache clinics have MOH. Furthermore, data suggests that it may be the third most frequent type of headache after migraine and tension-type headaches. While a Norwegian study found that people were seven times more likely to suffer from chronic headaches if they used analgesics (painkillers) daily or almost daily for more than a month.

Current research suggests that new treatment strategies should not be provided until the patient has undergone a detox of the overused medication.

“However data from recent trials indicate that treatments developed to prevent migraine may prove effective if they are used in patients with MOH before the overused medicine is withdrawn. This points to the need for clinical trials to re-evaluate current strategies and find the best way forward,” Prof Dodlick said.

He pointed out that while MOH is a universal problem, many countries face unique challenges due to the drugs that are available, patient and physician attitudes and different health care delivery systems.

“However, the overwhelming consensus is that MOH is a growing problem that has a major negative impact on health-related quality of life. It is important to identify patients with a high frequency of headaches, who are at high risk of MOH, as early as possible and initiate measures to reduce the consumption of acute pain medication,” Prof Dodlick added.

His comments are published in the journal, Cephalalgia. In the same issue, a number of other experts in this area also highlighted the need for ‘systematic and concerted research efforts to understand the mechanisms and most effective treatment strategies for MOH’.

[Posted: Mon 03/11/2008]