Migraine not just headache

Sunday, 8 June 2008

More on rebound

One of my "friends" on the migraine forum has commented on my confusion over the overuse/rebound thing. Thanks. Please feel free to comment on here too.
So here is part of an explanation on this:

• Medication-overuse headache (MOH) is defined as a headache that is present on 15 or more days of the month and has developed or worsened whilst the patient has been regularly using analgesic or anti-migraine medicines for more than three months. It occurs only in patients with a pre-existing primary headache disorder, usually migraine or tension-type headache.
• All drugs used for the treatment of headache can cause MOH. This includes simple analgesics (aspirin, paracetamol), opioids, triptans, non-steroidal anti-inflammatory drugs and ergots, alone or in combination with caffeine, barbiturates or benzodiazepines.
• Abrupt withdrawal of the overused medication is considered the most effective treatment. However patients on high-dose or strong opioids, benzodiazepines or barbiturates should have their medication withdrawn as inpatients.
• Patients are likely to require treatment to alleviate withdrawal symptoms. This should include adequate hydration, and, if unable to tolerate withdrawal symptoms, short-term regular agents of a different class to the overused medication, and anti-emetics.
• Relapse may be prevented through education of patients, use of headache diaries, extended close medical supervision, restrictions on the intake of headache medication, primary headache prophylactic drugs and use of behavioural therapies

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