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Understanding and Preventing Medication Overuse Headache

By Dr. Jaisingh Rajput

1. Headaches are one of the most common neurological complaints, and for many, over-the-counter pain medications seem like a quick fix. However, when these medications are taken too frequently, they can actually lead to a worsening of headaches—a condition known as Medication Overuse Headache (MOH).

Medication Overuse Headache

Medication Overuse Headache, also called rebound headache, occurs when pain-relieving medications are taken too frequently — typically more than 10-15 days per month — for at least three months. Rather than providing relief, the medications begin to contribute to a cycle of persistent or worsening headache.

According to the International Classification of Headache Disorders (ICHD-3), MOH most often affects individuals with a history of migraine or tension-type headaches and is more common among women and those aged 30-50.

Common Medication Headache Culprits

The medications most often associated with MOH include:

Acetaminophen Tylenol

NSAIDs (Ibuprofen, Naproxen)

Combination medications containing caffeine, aspirin, and acetaminophen

Triptans (migraine-specific drugs like sumatriptan)

Opioids (codeine, hydrocodone)

Signs and symptoms Include: daily or near-daily headaches; headaches that improve temporarily with medication, then return; nausea, restlessness or trouble sleeping and Increased sensitivity to light and sound.

Avoid Medication Overuse Headache

1. Limit Use of Acute Medications: The American Headache Society recommends avoiding acute headache medications on more than two days per week.

2. Track Headache Frequency and Medication Use: Use a headache diary to identify patterns and triggers and to avoid overuse.

 

3. Treat the Underlying Condition: Managing chronic migraines or tension-type headaches with preventive therapy can reduce the need for acute medications.

4. Educate Yourself and Family Members: Many patients are unaware that taking common OTC medications too often can lead to chronic headaches.

Treatment Options

1. Withdrawal of Overused Medications: Gradual tapering or abrupt discontinuation, depending on the medication. This may initially worsen headache symptoms (withdrawal period may last a few days to two weeks).

2. Preventive Medications: contact your physician for its treatment.

3. Non-Medication Approaches: Behavioral therapy and biofeedback. Practice getting regular sleep, hydration and stress management. Get physical therapy for posture and muscle tension.

4. Referral to a Headache Specialist

For complex or treatment-resistant cases, a neurologist or headache clinic may provide specialized care.

New Guidelines (2024-2025 Update)

The American Academy of Neurology (AAN) and European Headache Federation (EHF) emphasize the following in recent guidelines:

Avoid use of opioids and barbiturates in headache management

Early identification and patient education are key to prevention

Start preventive therapy early for patients with more than 4 headache days per month

Combine pharmacologic and non-pharmacologic therapies for better outcomes

Local Support in Greenville

Greenville Family Clinic offers headache management and medication review services.

Butler County Health Outreach provides free monthly headache and medication safety workshops.

Mind Body Wellness Center has CBT and stress management therapy.

Medication overuse headache is a growing yet preventable health concern. By staying informed, monitoring medication use, and seeking professional guidance, individuals can break the cycle of overuse and take control of their headaches—safely and effectively.

If you or a loved one experiences frequent headaches or relies heavily on pain medications, talk to your primary care physician..

Dr. Jaisingh Rajput and Dr. Prakakta Rajput are physicians specializing in hospital medicine and preventive health. They are dedicated to educating the public on stroke prevention and cardiovascular wellness.