Screening for Medication Overuse Headache Can Reduce Patients' Suffering From Chronic Daily Headache: A Case Report

Headache is one of the major global health problems and an economic burden on the population. Common causes of chronic daily headaches are migraine and tension-type headaches, respectively. Medication overuse headache (MOH) is one of the common secondary causes of chronic daily headaches. It appears if the original chronic headache was not treated properly and the patient excessively used over-the-counter medicines as an abortive medication. It can be diagnosed easily if the clinician asks for a detailed history and finds out if the patient fulfills the criteria of MOH. The management requires patient education and withdrawal of the medication use, which can be done successfully most of the time in an outpatient clinic. General practitioners are the initial encounter with this type of patient, so they must screen for this type of headache and establish management to reduce the patient's suffering and burden on other health care facilities.

Essential oils and cluster headache: insights from two cases

Essential oils with proconvulsive properties are known to cause seizures and may worsen migraine. Here, we report two cases of cluster headache temporally related to the use of toothpastes containing essential oils of camphor and eucalyptus.

Medication Overuse Headache

Background

Medication overuse headache (MOH) is one of the highly disabling headache disorder and affects about 1% of the population of the world. It is associated with the development of headache for 15 days or more, with consumption of acute symptomatic medications for 10-15 days (depending on the class of drug, like, simple analgesics, triptans, and opioids) in a month, used for relief of headache for three or more months, in a known patient of primary headache disorder.

Objective

The aim of this study was to review the topic of MOH and present the details of this disorder with an emphasis on recent updates in the field of pathophysiology and treatment.

Material and Methods

Literature search was performed in the PubMed/MEDLINE and Cochrane database with appropriate keywords and relevant full-text articles were reviewed for writing this article.

Results

Over the years, the concept of MOH has evolved, although the exact pathophysiology is still being explored. In a susceptible individual interplay of genetics, change in pain pathways, changes in areas of the brain associated with the perception of pain, and changes in the neurotransmitters have been implicated. It has to be differentiated from other secondary chronic daily headache disorders, by a careful history, targeted examination, details of intake of medications. Treatment predominantly involves patient education, removal of the offending agent, and initiation of prophylactic medications for primary headache disorder in the outpatient or inpatient services.

Conclusions

MOH is a secondary headache disorder, which should be considered in any chronic headache patient. There are various pathophysiological mechanisms attributed to its development. Management includes educating the patients about the disorder, detoxification, and prophylactic therapy.