Medication overuse headache (MOH)
"remains an important problem," but the drugs most likely
associated with the overuse have changed dramatically
in the past 15 years, according to headache specialists.
Triptans, like sumatriptan, are
now an important cause of probable MOH, although these
drugs cause headaches less frequently than do other medications,
report Dr. Chelsea A. Meskunas from Princeton University
in New Jersey and colleagues. Non-steroidal anti-inflammatory
drugs ( NSAIDs)
such as ibuprofen are more important now than they were
in the past, whereas ergotamine overuse is very rare.
Excessive use of anti-headache medication can lead to
MOH. Although evidence suggests that frequent use of analgesics
does not, per se, cause frequent headaches in everyone,
in people who suffer migraines, overuse of painkillers
is associated with an increase in the frequency of headaches,
Meskunas and colleagues note. Frequent use of these medications
may also render them less effective.
"Since many patients are overusing prescribed medications,
public health initiatives should focus on educating doctors
and patients about the importance of setting limits on
the prescription and taking of acute medication, emphasizing
that overuse of specific acute migraine medications may
also be associated with probable MOH," they conclude.
Meskunas and colleagues reviewed the charts of 1,200
acute headache patients seen at one headache center during
the years of 2005, 2000, 1995, and 1990. To gauge trends
in MOH, the investigators selected 300 patients per year
of interest.
The number of patients with a diagnosis of probable MOH
remained "remarkably stable" over the study period, varying
from 64 percent of all cases seen in the headache center
in 1990 to 59 percent in 2005, the team reports.
The relative frequency of probable ergotamine overuse
headache fell significantly, from 19 percent to 0 percent,
whereas the frequency of probable overuse headache involving
triptans, a newer class of drugs, rose significantly,
from 0 percent to 22 percent.
The frequency of overuse headache due to simple analgesics
increased from 8 percent to 32 percent, and for combinations
of acute medications from 10 percent to 23 percent. The
rate of opioid overuse headache declined, but the change
was not significant.
"Acquiring up-to-date knowledge on the substances associated
with probable MOH is a necessary step for planning strategies
to address and relieve the burden of a sizeable number
of headache patients," the authors write.
SOURCE: Headache May 2006
