Last month I released five videos about headaches, and I received many questions about medication
overuse headaches.
Today I will answer 5 questions: 1- What is medication overuse headache?
2- How do I know if my headache is caused by overuse of medications?
In other words, how do I know how much is too much?
3- My doctor wants me to stop taking these medications, but I don’t know how to do
it.
4- If I don’t take these medications, what else can I do for my headaches?
5- Is it okay to use these medications for other pain conditions, like menstrual cramps
or arthritis?
So, let’ ‘s talk about Medication Overuse Headaches
Before I continue, let me remind you that this video is not intended to provide medical
advice.
If you have a condition that causes pain, please talk to your doctor.
This video is only for educational purposes.
If there is an emergency, call an ambulance or go to the nearest emergency department.
1- What is medication overuse headache?
Basically, it is a headache that is caused by regular use of some medications for pain.
There are two types of headaches: primary and secondary.
Last month, I released 5 videos about headaches: Migraines, cluster headaches, and tension-type
headaches are primary headaches, while trigeminal neuralgia and cervicogenic headaches are secondary
headaches.
In primary headaches the pain system is sensitized, this is nociplastic pain.
When there is nociplastic pain, the pain system is malfunctioning and painkillers contribute
to the sensitization of the pain system.
That is why these types of chronic primary pains get worse with regular use of pain medications.
I have other videos that I explain central sensitization and nociplastic pain.
Almost all painkillers can cause medication overuse headache, especially when the cause
of headache is a primary pain, which is the case of migraine, cluster headaches and tension-type
headaches.
Here is a list of the medications that cause MOH:
In first place comes opioids and barbiturates.
Opioids are drugs like codeine, tramadol, oxycodone, morphine, fentanyl, and hydrocodone.
Butalbital is a barbiturate and it is found in a medication called Fiorinal, commonly
used to treat tension-type headaches.
In second place are the triptans.
Examples are Zomig, Imitrex, Maxalt, Amerge, Relpax and Axert.
In third place are the analgesics acetaminophen and NSAIDs.
If you want to learn more about them, check my other video.
2- How do I know if my headache is caused by the overuse of these medications?
In other words, how do I know how much is too much?
Actually, the person does not need to use it every day to have medication overuse headaches.
For opioids, barbiturates and triptans, using 10 days per month is enough to cause MOH.
For acetaminophen and NSAIDs, using 15 days per month is enough.
The best way to find out if your headache is caused by overuse of painkillers is to
gradually reduce the number of days you use them, until you are using them less than 2
days per week.
Then, wait at least 3 months.
If the headache improves then it means that your headaches were caused by that medication.
The best method to find out if you improved or not is by keeping a headache diary.
You should fill a diary for one full month before you try to stop the medication, and
then another full month after you reduced the medication.
If your headache intensity and frequency improved by more than 60%, it means your headache was
caused by that medication.
The treatment of Medication overuse headache is very easy and rewarding to treat, as patients
feel so much better.
3- My doctor wants me to stop taking these medications, but I don’t know how to do
it I don’t recommend the person to stop cold
turkey.
Talk to your doctor to get a detox plan.
You may need some alternative ways to treat the headache while you are reducing the offending
medication.
Sometimes, weaning the medication can be challenging, anespeciallyly with opioids, the patient may
have severe withdrawal symptoms and require medical assistance or admission to a hospital
foa detox from opioids and barbiturates.
4- If I don’t take these medications, what else can I do instead for my headaches?
In the other videos that I made for migraines, cluster headaches and tension-type headaches
I explained other treatments for these conditions.
There are many pharmacological and non-pharmacological options.
Remember the toolbox of mind-body treatments, movement, modalities, manual therapies and
medications.
There are medications that can be used to prevent headaches and migraines.
Talk to your doctor to find out if you are a candidate for preventative therapies.
5- Is it okay to use these medications for other pain conditions, like menstrual cramps
or arthritis?
If you use acetaminophen or NSAIDs, then it is safe to use for a few days.
If you need opioids, talk to your doctor, because a few days on opioids may trigger
medication overuse headaches very quickly.
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Goodbye