The Cleveland Clinic Manual of Headache Therapy by Stewart J. Tepper & Deborah E. Tepper

Author:Stewart J. Tepper & Deborah E. Tepper
Language: eng
Format: epub
Publisher: Springer US, New York, NY

Keywords Medication overuse headache – Chronic migraine – Rebound – Chronic daily headache – Medication wean – Transformation – Transformed migraine

* * *

Introduction

The treatment of medication overuse headache (MOH, rebound) is often the bane of a clinician’s existence. This need not be the case with simple and direct approaches based on a number of key points: (1) Prevention of MOH is always better than treating it after it occurs; (2) Treatment is predicated on absolute detoxification from overused medications. Partial measures are doomed to failure. (3) Prevention will not work fully, and migraine-specific medications will also not work fully until the wean is completed. (4) Do not get fancy. Use preventive medications that have evidence for effectiveness in prevention of episodic migraine, the underlying disorder behind MOH, or use onabotulinumtoxinA. (5) Multiple visits with education and reinforcement will be necessary during the wean and after. (6) Strict limits on as-needed acute medications are key.

The general gist of MOH is that a patient with episodic migraine transforms to chronic daily headache (CDH) or chronic migraine (CM), that is headaches at least 15 days per month at least 4 hours per day, in the setting of overuse of acute medications. Once that patient crosses the Rubicon to CDH, a number of clinical changes occur that interfere with treatment. These include reduced responsiveness to preventive and migraine-specific acute medications, non-restorative sleep disturbances, worsening of comorbid psychiatric issues, neck pain, vasomotor instability, and variability of headache symptoms across the days. Weaning the patient off the overused medications, providing preventive medication, initiating behavioral support, and prescribing acute medications with strict limits generally cuts the Gordian knot of CDH, restoring the effectiveness of prophylaxis and acute medications. General principles of treating MOH are listed in Table 11.1. Table 11.1 General principles of treating MOH

• Prevention of MOH is always better than treating MOH after it occurs

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.