Your SlideShare is downloading. ×
  • Like
  • Save
Medication overuse headache
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Now you can save presentations on your phone or tablet

Available for both IPhone and Android

Text the download link to your phone

Standard text messaging rates apply

Medication overuse headache

  • 180 views
Published

Brief review of diagnosis and management of medication-overuse headache, based on a continuum paper.

Brief review of diagnosis and management of medication-overuse headache, based on a continuum paper.

Published in Health & Medicine
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads

Views

Total Views
180
On SlideShare
0
From Embeds
0
Number of Embeds
0

Actions

Shares
Downloads
0
Comments
0
Likes
0

Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
    No notes for slide

Transcript

  • 1. Medication-overuse headache Daniel Vela-Duarte, MD PGY-3. Department of Neurology Loyola University Medical Center August 2013
  • 2. Definition  MOH (Medication-Overuse headache)  Secondary chronic daily headache Headache induced by the overuse of analgesics, triptans or other acute headache compounds, ocurring 15 days/month, 4hrs/day, per 3 months or more.   Repeated medication reaches a threshold causing transformation (chronification)
  • 3. Introduction / Epidemiology  Higher preponderance in woman  In a study on episodic migraineurs (n=532), the 1-year incidence of chronic headache was 14%, with a higher risk for patients who had a higher headache frequency at baseline and for patients taking greater amounts of analgesics.  Ergotamine, analgesics, barbiturates and caffeine  Poorer quality of life (Measured by scales: higher score on MIDAS: Migraine disability assessment scale)
  • 4. Clinical manifestations     Criteria established by the International Headache Society (IHS) in 2005 The primary headache disorder leading to MOH is migraine in most cases. MOH mainly occurs in patients with a primary headache disorder Comorbidities    Subclinical obsessive-compulsive disorder Anxiety - Mood disorders Type of medications overused.
  • 5. Symptoms  Circadian periodicity  Patients may be awakened from sleep or have onset upon arising  Neck pain / Cervicogenic pain.  Rhinorrhea, nasal stuffiness, postnasal drip, and ocular or gastrointestinal symptoms, likely caused by withdrawal and most evident in opioid rebound. Nonrestorative sleep disturbance 
  • 6. Diagnostic criteria Lancet Neurol 2010 Apr; 9(4): 391-401.
  • 7. Diagnostic criteria  There is no certainty whether combined drugs are more likely to cause MOH or not, compared to single substances.  The headache features of MOH caused by ergotamine derivatives are more severe than those caused by triptans.   Overuse of ergotamine + analgesics: daily tension-type-like headache, Overuse of triptans: (daily) migraine-like headache or an increase in migraine frequency
  • 8. Withdrawal treatment  Detoxification process  Improve responsiveness to acute and prophylactic drugs  Abrupt discontinuation vs. tapered withdrawal  Main symptoms of withdrawal  worsening of the headache  nausea, vomiting  arterial hypotension, tachycardia  sleep disturbances  restlessness, anxiety, nervousness
  • 9. Withdrawal treatment  Inpatient vs. Outpatient  Overuse of opioids, barbiturates, or benzodiazepines  psychological problems  severe medical comorbidities  severe withdrawal  symptoms (eg, vomiting and status migrainous)  previous medication withdrawal failure
  • 10. Tepper SJ, Continuum (Minneap Minn). 2012 Aug;18(4):807-22.