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Frank Porreca - One of the best experts on this subject based on the ideXlab platform.
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cannabinoids induce latent sensitization in a preclinical model of Medication Overuse headache
Cephalalgia, 2020Co-Authors: Caroline Machado Kopruszinski, Frank Porreca, David W. Dodick, Edita Navratilova, Barbora Vagnerova, Juliana Swiokla, Amol M PatwardhanAbstract:AimEvaluation of cannabinoid receptor agonists in a preclinical model of Medication Overuse headache.MethodsFemale Sprague Dawley rats received graded intraperitoneal doses of WIN55,212-2 or Δ-9-te...
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pathophysiology prevention and treatment of Medication Overuse headache
Lancet Neurology, 2019Co-Authors: Hans-christoph Diener, Frank Porreca, David William Dodick, Stefan Evers, Dagny Holle, R Jensen, Richard B Lipton, Stephen D Silberstein, Todd J SchwedtAbstract:Summary Regular or frequent use of analgesics and acute antimigraine drugs can increase the frequency of headache, and induce the transition from episodic to chronic headache or Medication Overuse headache. The 1-year prevalence of this condition in the general population is between 1% and 2%. Medication Overuse headache is more common in women and in people with comorbid depression, anxiety, and other chronic pain conditions. Treatment of Medication Overuse headache has three components. First, patients need education and counselling to reduce the intake of Medication for acute headache attacks. Second, some patients benefit from drug withdrawal (discontinuation of the Overused Medication). Finally, preventive drug therapy and non-medical prevention might be necessary in patients at onset of treatment or in patients who do not respond to the first two steps. The optimal therapeutic approach requires validation in controlled trials.
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sustained exposure to acute migraine Medications combined with repeated noxious stimulation dysregulates descending pain modulatory circuits relevance to Medication Overuse headache
Cephalalgia, 2019Co-Authors: Kelsey Nation, Frank Porreca, David W. Dodick, Edita NavratilovaAbstract:BackgroundLoss of conditioned pain modulation/diffuse noxious inhibitory controls has been demonstrated in patients with migraine and Medication Overuse headache. We hypothesized that exposure to a...
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Update on Medication-Overuse Headache
Current pain and headache reports, 2010Co-Authors: Milena De Felice, Michael H Ossipov, Frank PorrecaAbstract:Medication-Overuse headache (MOH) is a syndrome that can develop in migraineurs after Overuse of antimigraine drugs, including opiates and triptans especially. MOH manifests as increased frequency and intensity of migraine attacks and enhanced sensitivity to stimuli that elicit migraine episodes. Although the mechanisms underlying MOH remain unknown, it is hypothesized that repeated use of antimigraine drugs could elicit increased headache attacks as a consequence of neuronal plasticity that may increase responsiveness to migraine triggers. Preclinical studies show that exposure to either opiates or triptans can induce pronociceptive neuroadaptive changes in the orofacial division of the trigeminal ganglia that persist even after discontinuation of the drug treatment. Additionally, Medications can elicit increased descending facilitatory influences that may amplify evoked inputs from trigeminal afferents leading to behavioral hypersensitivity reminiscent of cutaneous allodynia observed clinically. Importantly, enhanced descending facilitation may manifest as an inhibition of diffuse noxious inhibitory control. Persistent, pronociceptive adaptations in nociceptors as well as within descending modulatory pathways thus may jointly contribute to the development of MOH.
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triptan induced latent sensitization a possible basis for Medication Overuse headache
Annals of Neurology, 2009Co-Authors: Milena De Felice, Ruizhong Wang, Juliana Geremias Chichorro, Ian D Meng, Todd W. Vanderah, Gregory Dussor, Michael H Ossipov, David William Dodick, Frank PorrecaAbstract:Objective Identification of the neural mechanisms underlying Medication Overuse headache resulting from triptans. Methods Triptans were administered systemically to rats by repeated intermittent injections or by continuous infusion over 6 days. Periorbital and hind paw sensory thresholds were measured to detect cutaneous allodynia. Immunofluorescent histochemistry was employed to detect changes in peptidic neurotransmitter expression in identified dural afferents. Enzyme-linked immunoabsorbent assay was used to measure calcitonin gene-related peptide (CGRP) levels in blood. Results Sustained or repeated administration of triptans to rats elicited time-dependent and reversible cutaneous tactile allodynia that was maintained throughout and transiently after drug delivery. Triptan administration increased labeling for CGRP in identified trigeminal dural afferents that persisted long after discontinuation of triptan exposure. Two weeks after triptan exposure, when sensory thresholds returned to baseline levels, rats showed enhanced cutaneous allodynia and increased CGRP in the blood following challenge with a nitric oxide donor. Triptan treatment thus induces a state of latent sensitization characterized by persistent pronociceptive neural adaptations in dural afferents and enhanced responses to an established trigger of migraine headache in humans. Interpretation Triptans represent the treatment of choice for moderate and severe migraine headaches. However, triptan Overuse can lead to an increased frequency of migraine headache. Overuse of these Medications could induce neural adaptations that result in a state of latent sensitization, which might increase sensitivity to migraine triggers. The latent sensitization could provide a mechanistic basis for the transformation of migraine to Medication Overuse headache. ANN NEUROL 2010;67:325–337
Rigmor Jensen - One of the best experts on this subject based on the ideXlab platform.
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complete detoxification is the most effective treatment of Medication Overuse headache a randomized controlled open label trial
Cephalalgia, 2018Co-Authors: Louise Ninett Carlsen, Signe Bruun Munksgaard, Rigmor Jensen, Lars BendtsenAbstract:Background There is lack of evidence on how to detoxify Medication-Overuse headache. Aim To compare the effect of complete stop of acute Medication with restricted intake. Methods Medication-Overuse headache patients were included in a prospective, outpatient study and randomized to two months' detoxification with either a) no analgesics or acute migraine-Medication (program A), or b) acute Medication restricted to two days/week (program B). Detoxification was followed by preventives if indicated. Patients were followed up at 2, 6 and 12 months. Percentage reduction in headache days/month after 6 months was the primary outcome. Results We included 72 Medication-Overuse headache patients with a primary migraine and/or tension-type headache diagnosis. Fifty-nine completed detoxification, 58 (81%) were followed up at month 6 and 53 (74%) at month 12. At month 6, program A reduced headache days/month by 46% (95% CI 34-58) compared with 22% (95% CI 11-34) in program-B ( p = 0.005), and 70% in program A versus 42% in program B were reverted to episodic headache ( p = 0.04). Migraine-days/month were reduced by 7.2 in program A ( p < 0.001) and 3.6 in program B ( p = 0.002) after 6 months. Conclusion Both detoxification programs were very effective. Detoxification without analgesics or acute migraine-Medication was the most effective program. Trial registration Clinicaltrials.gov (NCT02903329).
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Medication-Overuse headache: a perspective review:
Therapeutic advances in drug safety, 2016Co-Authors: Maria Lurenda Westergaard, Signe Bruun Munksgaard, Lars Bendtsen, Rigmor JensenAbstract:Medication-Overuse headache (MOH) is a debilitating condition in which frequent and prolonged use of Medication for the acute treatment of pain results in the worsening of the headache. The purpose of this paper is to review the most recent literature on MOH and discuss future avenues for research. MOH accounts for a substantial share of the global burden of disease. Prevalence is often reported as 1-2% but can be as high as 7% overall, with higher proportions among women and in those with a low socioeconomic position. Management consists of withdrawing pain Medication, focusing on prophylactic and nonmedical treatments, and limiting acute symptomatic Medication. Stress reduction and lifestyle interventions may support the change towards rational pain Medication use. Support, follow up, and education are needed to help patients through the detoxification period. There is fertile ground for research in MOH epidemiology, pathophysiology, and neuroimaging. Randomized and long-term follow-up studies on MOH treatment protocols are needed. Further focused research could be of major importance for global health.
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Medication Overuse healthy lifestyle behaviour and stress in chronic headache results from a population based representative survey
Cephalalgia, 2016Co-Authors: Maria Lurenda Westergaard, Charlotte Glumer, Ebba Holme Hansen, Rigmor JensenAbstract:AimThis cross-sectional study investigated associations between chronic headache (CH) with and without Medication Overuse, healthy lifestyle behaviour, and stress.MethodsQuestionnaires were sent to 129,150 adults. Those with headache ≥15 days per month for three months were classified as having CH then further described as having Medication-Overuse headache (MOH) or CH without Medication Overuse. Associations between headache and daily smoking, physical inactivity, obesity, excessive drinking, illicit drug use, and high stress were analysed by logistic regression.ResultsCH with and without Medication Overuse (prevalence 1.8% and 1.6%, respectively) had strong, graded associations with stress. Associations with daily smoking, physical inactivity, and obesity were significant only for MOH. Odds for MOH were highest among people who had all three factors compared to those who had none (OR 2.8 in women and 5.1 in men). High stress plus any of these three factors had synergistic effects in MOH but not clearly ...
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prescription pain Medications and chronic headache in denmark implications for preventing Medication Overuse
European Journal of Clinical Pharmacology, 2015Co-Authors: Maria Lurenda Westergaard, Charlotte Glumer, Ebba Holme Hansen, Rigmor JensenAbstract:Purpose The aim of the present paper is to study which prescription pain Medications are most commonly dispensed to people with chronic headache (CH), particularly those with Medication-Overuse headache (MOH).
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prevalence of chronic headache with and without Medication Overuse associations with socioeconomic position and physical and mental health status
Pain, 2014Co-Authors: Maria Lurenda Westergaard, Charlotte Glumer, Ebba Holme Hansen, Rigmor JensenAbstract:Abstract Near-daily intake of acute symptomatic Medication for frequent headache increases the risk for Medication-Overuse headache (MOH). Chronic headache (CH) and MOH prevalences are inversely related to socioeconomic position (SEP). It is not known how SEP influences the health status of people with these headaches. This cross-sectional study examined the prevalence of CH in Denmark; possible associations between CH and education, work status, and income; and the health status of people with CH across socioeconomic strata. A total of 129,150 individuals aged ⩾16 years were invited to the 2010 Danish National Health Survey. Data on SEP indicators and purchases of prescription drugs in 2009 were retrieved from national registers. Respondents with headache ⩾15 days per month over 3 months were classified as having CH. Those with concurrent over-the-counter analgesic intake of ⩾15 days per month or prescription Medication Overuse (⩾20 or ⩾30 defined daily doses per month depending on the drug or drugs) were classified as having MOH. Associations between headache and SEP were analyzed by logistic regression, and associations between headache and health status scores, by linear regression. Physical and mental health composite scores (SF-12) were summarized per headache group, stratified by SEP, and compared to the sample mean. Analyses were adjusted for stratified sampling and nonresponse. The response rate was 53.1%. CH prevalence was 3.3% with 53.0% of cases having concurrent Medication Overuse (MOH prevalence 1.8%). CH was more prevalent among those individuals with low SEP. Health status scores were significantly lower among persons with CH in all SEP categories. The burden of CH can be reduced by preventing and treating MOH.
Hans-christoph Diener - One of the best experts on this subject based on the ideXlab platform.
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pathophysiology prevention and treatment of Medication Overuse headache
Lancet Neurology, 2019Co-Authors: Hans-christoph Diener, Frank Porreca, David William Dodick, Stefan Evers, Dagny Holle, R Jensen, Richard B Lipton, Stephen D Silberstein, Todd J SchwedtAbstract:Summary Regular or frequent use of analgesics and acute antimigraine drugs can increase the frequency of headache, and induce the transition from episodic to chronic headache or Medication Overuse headache. The 1-year prevalence of this condition in the general population is between 1% and 2%. Medication Overuse headache is more common in women and in people with comorbid depression, anxiety, and other chronic pain conditions. Treatment of Medication Overuse headache has three components. First, patients need education and counselling to reduce the intake of Medication for acute headache attacks. Second, some patients benefit from drug withdrawal (discontinuation of the Overused Medication). Finally, preventive drug therapy and non-medical prevention might be necessary in patients at onset of treatment or in patients who do not respond to the first two steps. The optimal therapeutic approach requires validation in controlled trials.
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erenumab in chronic migraine with Medication Overuse subgroup analysis of a randomized trial
Neurology, 2019Co-Authors: Hans-christoph Diener, Messoud Ashina, Jan Lewis Brandes, Deborah I Friedman, Uwe Reuter, Sunfa Cheng, Jon Nilsen, Dean Leonardi, Robert A LenzAbstract:Objective To determine the effect of erenumab, a human anti-calcitonin gene-related peptide receptor monoclonal antibody, in patients with chronic migraine and Medication Overuse. Methods In this double-blind, placebo-controlled study, 667 adults with chronic migraine were randomized (3:2:2) to placebo or erenumab (70 or 140 mg), stratified by region and Medication Overuse status. Data from patients with baseline Medication Overuse at baseline were used to assess changes in monthly migraine days, acute migraine-specific Medication treatment days, and proportion of patients achieving ≥50% reduction from baseline in monthly migraine days. Results Of 667 patients randomized, 41% (n = 274) met Medication Overuse criteria. In the Medication Overuse subgroup, erenumab 70 or 140 mg groups had greater reductions than the placebo group at month 3 in monthly migraine days (mean [95% confidence interval] −6.6 [−8.0 to −5.3] and −6.6 [−8.0 to −5.3] vs −3.5 [−4.6 to −2.4]) and acute migraine-specific Medication treatment days (−5.4 [−6.5 to −4.4] and −4.9 [−6.0 to −3.8] vs −2.1 [−3.0 to −1.2]). In the placebo and 70 and 140 mg groups, ≥50% reductions in monthly migraine days were achieved by 18%, 36% (odds ratio [95% confidence interval] 2.67 [1.36–5.22]) and 35% (odds ratio 2.51 [1.28–4.94]). These clinical responses paralleled improvements in patient-reported outcomes with a consistent benefit of erenumab across multiple measures of impact, disability, and health-related quality of life. The observed treatment effects were similar in the non–Medication Overuse subgroup. Conclusions Erenumab reduced migraine frequency and acute migraine-specific Medication treatment days in patients with chronic migraine and Medication Overuse, improving disability and quality of life. Clinicaltrials.gov identifier NCT02066415. Classification of evidence This study provides Class II evidence that erenumab reduces monthly migraine days at 3 months in patients with chronic migraine and Medication Overuse.
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Medication Overuse in chronic daily headache
2019Co-Authors: Hans-christoph Diener, Dagny Hollelee, Frederick G. FreitagAbstract:The frequent or regular intake of Medication to treat acute headache episodes can lead to an increase in headache frequency and finally to a transition from episodic to chronic headache. Many patients with chronic headache take abortive Medication on a daily basis. Medication Overuse headache (MOH) is defined by the International Classification of Headache Disorders as a headache in patients with a pre-existing primary headache disorder (e.g., migraine or tension-type headache) occurring on ≥15 days per month for >3 months. Also, these primary headache disorders occur in association with Overuse of Medication for acute or symptomatic headache treatment. The prevalence of MOH in the general population is around 1%. MOH is more common in people with chronic migraine and chronic daily headache than in patients with episodic migraine. The phenotype of the headache in MOH depends on the initial primary headache and the type of Overused acute Medication. Treatment of MOH occurs in three stages. First, we educate patients about the relationship between frequent intake of acute headache Medication and MOH to reduce intake of acute Medication. In a second step migraine prevention should be initiated in chronic migraine (topiramate or onabotulinumtoxinA in migraine) or amitriptyline in chronic tension-type headache. In patients who fail to cease Overuse of Overused Medication with preventive therapy, then detoxification occurs on an outpatient basis or in a day hospital or inpatient setting, depending on severity and comorbidities. The success rate of treatment is around 50–70%, with higher relapse rates in patients with opioid Overuse. Patient education and continuity of care in the follow-up period reduce relapse rates.
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detoxification for Medication Overuse headache is not necessary
Cephalalgia, 2012Co-Authors: Hans-christoph DienerAbstract:Background: Current textbook knowledge states that patients with chronic migraine and Medication Overuse should be withdrawn from acute Medication before initiating preventive drug therapy.Overview...
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prevention of Medication Overuse in patients with migraine
Pain, 2010Co-Authors: Gunther Fritsche, Jule Frettloh, M Huppe, Martha Dlugaj, Nadine Matatko, Charly Gaul, Hans-christoph DienerAbstract:This multi-center study compared the therapeutic effect of a cognitive-behavioral minimal contact program (MCT) to the effect of a brochure (bibliotherapy) for the prevention of Medication Overuse headache (MOH) in migraine patients. Seven German headache centers recruited 182 migraine patients with high triptan or analgesic intake frequency. Patients were randomly allocated to either the MCT-group, receiving both an MCT program and an educational brochure or to the biblio-group receiving only the brochure. All participants continued usual medical treatment. Course of headaches, intake of analgesics or triptans after training, 3 months post-training as well as 1-2 years (mean 15.7 months) later and psychological variables were defined as outcome variables. A significant decline was observed in the number of headache days (11.0-8.8), migraine days (7.3-5.7) and Medication intake days (7.4-6.1) from pre to post in the MCT-group (p<0.001 each) and in the biblio-group (p<0.001 each). The pre-to-post-improvements were maintained from pre- to short- and from pre- to long-term follow-up (p<0.001 each) in both groups. Both groups improved significantly from pre to post in psychological variables, e.g. pain acceptance: p<0.001; pain catastrophizing: p<0.001; functional pain coping: p<0.001; and pain related internal control beliefs: p<0.01. Psychological improvements remained stable in both groups at short- and long-term follow-up. During the study, none of the patients developed an MOH. MCT- and bibliotherapy are useful in migraine patients to prevent Medication Overuse headache or the transition of episodic to chronic headache.
David Dellamorte - One of the best experts on this subject based on the ideXlab platform.
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dopamine beta hydroxylase 19 bp insertion deletion polymorphism affects Medication Overuse in patients with chronic migraine
Neurological Sciences, 2019Co-Authors: Piero Barbanti, Fiorella Guadagni, Maria Laura De Marchis, Cristiano Ialongo, Gabriella Egeo, Luisa Fofi, Cinzia Aurilia, Domenica Lovero, David DellamorteAbstract:Dopamine-beta-hydroxylase (DBH) enzyme activity is modulated at the genetic level by the presence of several polymorphisms. Among these, the 19-bp insertion/deletion (I/D) polymorphism (rs72393728/rs141116007) was investigated in several genetic association studies for its correlation with the susceptibility to develop episodic migraine, but conflicting results were achieved. In the present study we analyzed this genetic variant in a carefully characterized population of migraineurs encompassing both episodic and chronic migraine (with and without Medication Overuse) with the aim to perform a replication study and verify any possible correlation with migraine endophenotypes. Genotyping of the DBH 19-bp I/D polymorphism was performed on 400 migraine patients and 204 healthy individuals. The associations between genotypic frequencies and the clinical and sociodemographic features of migraineurs were then investigated. The DBH 19-bp I/D polymorphism did not correlate with migraine susceptibility or most clinical variables, with the exception of a statistically significant correlation within the subgroup of patients affected by chronic migraine were the individuals carrying the deleted (D) allele were significantly more prone to abuse in analgesics. As a result of this finding, the DBH 19-bp I/D polymorphism does not influence migraine susceptibility, but it might contribute to the development of Medication Overuse in patient with chronic migraine.
Todd J Schwedt - One of the best experts on this subject based on the ideXlab platform.
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Medication Overuse and headache burden results from the cameo study
Neurology: Clinical Practice, 2021Co-Authors: Todd J Schwedt, Dawn C Buse, Charles Argoff, Michael L Reed, Kristina M Fanning, Cory R Hussar, Aubrey Manack Adams, Richard B LiptonAbstract:Objective To estimate the relative frequency of acute Medication Overuse (AMO) among people with episodic migraine and chronic migraine, to characterize the types of acute Medications Overused for migraine, and to identify factors associated with AMO. Methods We analyzed data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study (ClinicalTrials.gov, NCT01648530), a cross-sectional and longitudinal internet study that included a systematic sampling of the US population. From September 2012 to November 2013, the CaMEO Study respondents participated in different modules to collect data on the clinical course of migraine, family burden, barriers to care, endophenotypes, and comorbidities. Among people who met the criteria for migraine consistent with the International Classification of Headache Disorders, third edition (ICHD-3), we evaluated types and frequency of Medications used for headache/migraine, selected comorbidities, and emergency department (ED) and urgent care (UC) use. AMO was defined by days per month of Medication use as specified by ICHD-3 criteria for Medication Overuse headache (MOH) without the requirement for ≥15 monthly headache days (MHDs). Nested, multivariable binary logistic regression modeling was used to identify factors associated with an increased risk of AMO. Results Of 16,789 CaMEO respondents with migraine, 2,975 (17.7%) met the AMO criteria. Approximately 67.9% (2,021/2,975) of AMO respondents reported <15 MHDs. Simple analgesics, combination analgesics, and opioids were the Medication classes most commonly Overused. Factors associated with AMO in the final multivariable logistic regression model included ≥15 MHDs, moderate to severe disability, severe migraine interictal burden, use of preventive Medication, and an ED/UC visit for headache within 6 months. Conclusions Approximately two-thirds of respondents with AMO reported <15 MHDs and therefore did not meet the criteria for MOH. Those with AMO had greater disease burden and increased ED/UC utilization relative to people with migraine but not AMO.
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Medication Overuse and headache burden results from the cameo study
Neurology: Clinical Practice, 2021Co-Authors: Todd J Schwedt, Dawn C Buse, Charles Argoff, Michael L Reed, Kristina M Fanning, Cory R Hussar, Aubrey Manack Adams, Richard B LiptonAbstract:Abstract Objective: To estimate the relative frequency of acute Medication Overuse (AMO) among people with episodic migraine (EM) and chronic migraine (CM), to characterize the types of acute Medications Overused for migraine, and to identify factors associated with AMO. Methods: We analyzed data from the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study (ClinicalTrials.gov, NCT01648530), a cross-sectional and longitudinal Internet study that included a systematic sampling of the US population. From September 2012 to November 2013, the CaMEO Study respondents participated in different modules to collect data on the clinical course of migraine, family burden, barriers to care, endophenotypes, and comorbidities. Among people who met criteria for migraine consistent with the International Classification of Headache Disorders, 3rd edition (ICHD-3), we evaluated types and frequency of Medications used for headache/migraine, selected comorbidities, and emergency department (ED) and urgent care (UC) use. AMO was defined by days/month of Medication use as specified by ICHD-3 criteria for Medication Overuse headache (MOH) without the requirement for ≥15 monthly headache days (MHDs). Nested, multivariable binary logistic regression modeling was used to identify factors associated with increased risk of AMO. Results: Of 16,789 CaMEO respondents with migraine, 2,975 (17.7%) met AMO criteria. Approximately 67.9% (2,021/2,975) of AMO respondents reported Conclusions: Approximately two-thirds of respondents with AMO reported
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headache characteristics and burden from chronic migraine with Medication Overuse headache cross sectional observations from the Medication Overuse treatment strategy trial
Headache, 2021Co-Authors: Todd J Schwedt, Joseph G Hentz, Soma Sahaisrivastava, Nicole M Spare, Vincent T Martin, Christina Treppendahl, Kathleen B Digre, Nathan L Bennett, Marius Birlea, David WatsonAbstract:Objective To describe headache characteristics, Medication use, disability, and quality of life in a large patient cohort from the United States who have chronic migraine (CM) and Medication Overuse headache (MOH). Methods In all, 610 adult patients were enrolled into the Medication Overuse Treatment Strategy trial from 34 healthcare clinics, including headache specialty, general neurology, and primary care clinics. Descriptive statistics characterize baseline demographics, headache characteristics, Medication use, disability (Headache Impact Test 6 [HIT-6] and Migraine Functional Impact Questionnaire [MFIQ]), pain interference (PROMIS Pain Interference), and quality of life (EQ-5D-5L). Relationships with headache frequency were assessed. Results Mean age was 45 years (SD 13) and 531/608 (87.3%) were females. Mean headache days per 30 was 24.3 (SD 5.5), including 13.6 (SD 7.1) with moderate to severe headache. Daily headaches were reported by 36.1% (219/607) of patients. Acute headache Medications were used on 21.5 (SD 7.5) per 30 days. The most commonly Overused Medications were simple analgesics (378/607, 62% of patients), combination analgesics (246/607, 41%), and triptans (128/607, 21%). HIT-6, MFIQ, PROMIS Pain Interference, and EQ-5D-5L scores demonstrated substantial negative impact from CM with MOH on patient functioning and quality of life. Higher headache frequency was associated with more moderate-severe headache days, more frequent acute headache Medication use, greater headache-related disability, and lower quality of life. Only 272/606 (44.9%) were taking migraine preventive Medication. Conclusions CM with MOH is associated with a large burden on patients in the United States. Higher headache frequency is associated with greater impact on functioning, pain interference, and quality of life.
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pathophysiology prevention and treatment of Medication Overuse headache
Lancet Neurology, 2019Co-Authors: Hans-christoph Diener, Frank Porreca, David William Dodick, Stefan Evers, Dagny Holle, R Jensen, Richard B Lipton, Stephen D Silberstein, Todd J SchwedtAbstract:Summary Regular or frequent use of analgesics and acute antimigraine drugs can increase the frequency of headache, and induce the transition from episodic to chronic headache or Medication Overuse headache. The 1-year prevalence of this condition in the general population is between 1% and 2%. Medication Overuse headache is more common in women and in people with comorbid depression, anxiety, and other chronic pain conditions. Treatment of Medication Overuse headache has three components. First, patients need education and counselling to reduce the intake of Medication for acute headache attacks. Second, some patients benefit from drug withdrawal (discontinuation of the Overused Medication). Finally, preventive drug therapy and non-medical prevention might be necessary in patients at onset of treatment or in patients who do not respond to the first two steps. The optimal therapeutic approach requires validation in controlled trials.
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Medication Overuse headache pathophysiological insights from structural and functional brain mri research
Headache, 2017Co-Authors: Todd J Schwedt, Catherine D ChongAbstract:Background Research imaging of brain structure and function has helped to elucidate the pathophysiology of Medication Overuse headache (MOH). Methods This is a narrative review of imaging research studies that have investigated brain structural and functional alterations associated with MOH. Studies included in this review have investigated abnormal structure and function of pain processing regions in people with MOH, functional patterns that might predispose individuals to development of MOH, similarity of brain functional patterns in patients with MOH to those found in people with addiction, brain structure that could predict headache improvement following discontinuation of the Overused Medication, and changes in brain structure and function after discontinuation of Medication Overuse. Results and Conclusions MOH is associated with atypical structure and function of brain regions responsible for pain processing as well as brain regions that are commonly implicated in addiction. Several studies have shown “normalization” of structure and function in pain processing regions following discontinuation of the Overused Medication and resolution of MOH. However, some of the abnormalities in regions also implicated in addiction tend to persist following discontinuation of the Overused Medication, suggesting that they are a brain trait that predisposes certain individuals to Medication Overuse and MOH.