Medication Overuse Headache
Medication Overuse Headache (MOH) occurs when medications are taken too often causing chronic headache. MOH is severe, disabling and all-too common. It is a well-documented condition now1 and is the third-most prevalent headache type worldwide2.
Many analgesics or painkillers are not intended to be taken frequently, however when the pain of headache or migraine is severe and frequent enough, many sufferers often reach for any relief necessary and are not aware of other safer and better evidenced-based alternatives. Sadly, many are also not aware of the harmful side effects to their body or the fact that overuse of some medications can actually cause Headache.
Another name for MOH is Rebound Headache. Rebound Headache or MOH often occur daily, can be very painful and is a common cause of Chronic Daily Headache. The most common offenders are:
- Simple pain relievers. The most common pain relievers such as aspirin and paracetamol may contribute to MOH rebound headaches — especially if you exceed the recommended daily dosages.
- Combination pain relievers. Over-the-counter (OTC) pain relievers that combine caffeine, aspirin and paracetamol are common culprits. OTC meds often include prescriptions with a sedative effect (butalbital, anti-histamines etc) that have an especially high risk of causing MOH rebound headaches.
- Targeted migraine medications. Various migraine medications have been linked with rebound headaches, including triptans (Imitrex, Zomig, maxalt etc) and certain ergots. These medications have a moderate risk of causing MOH.
- Opiates. Painkillers derived from opium or from synthetic opium compounds as stand alone or in combination with other substances are highly addictive have a high risk of causing MOH rebound headaches. The most common in Australia being mersyndol, oxycodone, and codeine based painkillers.
What is the Cause of Medication Overuse Headache?
Pain, and lots of it. The pain intensity and dominating nature of headache and migraine pain combined with lack of a proper diagnosis or assessment and the common dissatisfaction with current treatment are the most common reasons for someone to often self-medicate or overuse their prescribed medications.
Thankfully, there are now many alternatives to frequent use of medication as a mainline migraine or headache treatment. In fact, that is what we as a clinic are dedicated to, and our reason for partnership with the charity “Lifting the burden: the Global campaign for relief of headache.
More good news is that science is now revealing what every chronic headache sufferer knew all along, namely it’s not “all in your head!” 3. What is emerging from the research is the fact of a common pathway or “headache headquarters” in the brainstem where multiple neurons converge. This specific region is called the Trigeminocervical complex (TCC) and is a “holy grail” of sorts for researchers, clinicians and sufferers alike. Furthermore, recent studies have revealed that one of the most powerful causes of brainstem sensitivity is the upper neck or Cervical spine4,6,7.
Even between an episode or attack, research shows that chronic headache patients exhibit a sensitized brainstem. Once this portion of the brainstem is fired up enough, even normal everyday stressors (like prolonged or poor posture, stress, medication oversue etc) trigger an already sensitized brainstem leading to an attack of nasty pain. Therefore, the real cause of the pain of MOH is a combination of medications perpetuating this underlying and inherent neurological condition.
The good news is research emphatically reveals that the MOH, neck dysfunction and other triggers along with the brainstem sensitivity they cause CAN be treated with an integrated and combined therapy approach, with a critical first step being expert screening of the upper neck as a primary contributor of sensitivity in the brainstem3,4.
A high level research Cochrane Review 8 found “both neck exercise (low intensity, endurance training) and spinal manipulation are effective in the short term and the long term” for chronic headache. Moreover, in a 2002 study by Jull et al.9 with similar combined interventions they demonstrated statistically significant decreases in neck pain, headache frequency and intensity at follow-up at 7 weeks and 12 months, ranging from 50% better to complete resolution.
Also interestingly in this study, medication use decreased in the combined therapy group by an impressive 93%, underlying the efficacy and importance of physiotherapy and a combined approach in the treatment of Cervicogenic headaches (CGH).
Our unique combined therapy approach is logical and evidence-based and aimed at decreasing the sensitivity in the brainstem at the “headache headquarters” with a number of safe treatment options individualized to your headache type.
Click the links for more information on how we perform Our Assessment or Our Treatment or to learn more about our revolutionary 4 phase S.T.E.P. into FREEDOM TM program to help you live life headache free!
- “The International Headache Classification” http://ihs-classification.org/ The international Headache Society.
- Diener HC, Limmroth V (2004). “Medication-overuse headache: a worldwide problem”. Lancet Neurol 3 (8): 475-83
- Jull G, Amiri M, Bullock-Saxton J, Darnell R, Lander C ; ‘Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: Subjects with single headaches’ Cephalgia 2007; 27:793–802
- Watson D, (2015) “Sensitive New Age Migraine”; video lecture
- Steiner TJ, Birbeck GL, Jensen R, et al. Lifting The Burden: The first 7 years. J Headache Pain (2010); 11: 451–455.
- Watson D. and Drummond (2014). “Cervical Referral of Head Pain in Migraineurs: Effects on the Nociceptive Blink Reflex””Cephalalgia. 54: 1035-1045. Doi 10.1111/head.12335.
- Watson, D. Drummond, P.D. (2012). “Head Pain Referral During Examination of the Neck in Migraine and Tension-Type Headache”. Headache. 52: 1226-1235. Doi: 10.1111/j.1526-4610.2012.02169.x
8, Bronfort G, Nilsson N, Haas M, et al. Non-invasive physical treatments for chronic/recurrent headache. Cochrane Database Syst Rev. 2004;(3)
- Jull G, Trott P, Potter H, et al. A randomized controlled trial of exercise and manipulative therapy for cervicogenic headache. Spine. 2002;27:1835–1843
The Headache + Migraine Clinic
Telephone: 1300 HOPE 4 YOU (1300 467 349)
Brisbane West (Springfield Central)
Suite 3, Level 1, Orion Springfield Central
1 Main Street, Springfield Central QLD 4300