Risk of headache associated with overuse of medications used for the treatment of acute migraine

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Risk of headache associated with overuse of medications used for the treatment of acute migraine

Headache associated with the overuse of medication is known as Medication-overuse headache (MOH) and it is caused by the overuse of medications prescribed for migraines or other pain disorders. It can be defined as the headache occurred for 15 or more than 15 days per month, developed as a consequence of regular overuse of acute or symptomatic headache medications.

 It manifests the increased frequency and intensity of headaches or migraine attacks with enhanced sensitivity to stimuli that elicit these episodes. Common medications commonly prescribed to treat migraine include analgesics, ergots, opioids and triptans. Because the mechanism of action of different drug classes vary, it is believed that some classes might be less likely to elicit the MOH than others.

 Thorlund K et al conducted a study to determine certain classes of acute migraine drugs which are more likely to elicit MOH than others. In this study, a comprehensive systematic literature was investigated to identify the studies of different designs reporting MOH within the considered treatment classes. Studies reporting MOH and those conducted per the International Classification of Headache Disorders (ICHD) were considered. Since no causal comparative designed studies were identified, data from prevalence studies and surveys were retrieved. Prevalence based relative risks between different treatment classes were also calculated using the integrated medication overuse and medication use from published studies. For comparison of each pair, pooled relative risks were calculated as the inverse variance weighted average.

 Analysis of showed that the all 20 studies contained  country-specific data, while 5 studies reported the country-specific medication use data. For triptans versus analgesics, the study relative risks generally favored triptans. The pooled relative risk was reported to be 0.65. Between ergots and analgesics, a similar trend was observed in favor of ergots with a relative risk of 0.41. For triptans versus ergots, the direction of effect was mixed and the pooled relative risk reported was 1.07.

 Results showed that both triptans and ergots appeared to be favorable when compared to the opioids with the pooled relative risks of 0.35 and 0.76, respectively. However, the evidence was limited for these comparison only. Analgesics and opioids also appeared to yield the similar risks of MOH.

 It  can be concluded that the patients receiving the acute migraine treatment, analgesics and opioids are associated with the higher risk of MOH as compared to other treatments. The findings provided the incentive for better monitoring of use of analgesics and opioids for treating the acute migraine and suggested the possible clinical preference for use of so called “migraine-specific” treatments that is triptans and ergots. 



The Journal of Headache and Pain

Link to the source:


Original title of article:

Risk of medication overuse headache across classes of treatments for acute migraine


Kristian Thorlund, Christina Sun-Edelstein, Eric Druyts, Steve Kanters, Shanil Ebrahim, Rahul Bhambri, Elodie Ramos, Edward J. Mills, Michel Lanteri-Minet and Stewart Tepper

The Journal of Headache and Pain
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