How clinicians can detect, prevent and treat medication overuse headache

摘要

Medication overuse headache (MOH) (previously referred to as rebound headache, drug-induced headache or drug-misuse headache) is denned as daily or near-daily headache (>= 15 days per month) that occurs in patients with a primary headache disorder who overuse acute medications (1). Tolerance to the analgesic effect of the acute medication develops over time, consumption may increase and patients may show withdrawal symptoms upon discontinuing the overused medication (2).The prevalence of MOH in the general population worldwide is at least 1% in adults and 0.5% in adolescents (3-5). Among those individuals with chronic daily headache (CDH), approximately one-third (4, 6-8) meet the criteria for medication overuse (MO); the rates are higher in specialty and tertiary care centres (9, 10). In the USA, for example, up to 60% of patients with CDH seen in headache clinics have MO (9). In an earlier study, 87% of patients with CDH seen in a headache clinic over a 3-year period consumed at least 14 analgesic tablets per week (10). Data from a physician survey that included neurologists, headache specialists and general practitioners suggested that MOH may be the third most frequent type of headache after migraine and tension-type headaches(11).