Medication-overuse headache (MOH) is also called analgesic rebound headache. MOH is a fairly common and treatable condition. It is closely related to chronic migraine. According to the International Classification of Headache Disorders (ICHD), third edition, MOH occurs in patients with a pre-existing primary headache disorder who experience headaches on 15 or more days per month, as a consequence of the regular overuse of acute or symptomatic headache medications (on 10 or more days, or 15 or more days per month, depending on the medication) for more than three months. MOH usually resolves once the overused medication is withdrawn.
The most frequently overused medications are available over-the-counter, such as Tylenol, Excedrin, Advil, ibuprofen, and aspirin. The most frequently overused prescription drugs are triptans, opioids, and barbiturates.
The first step in treating MOH is to recognize it. It may be hard for the patient to comprehend or accept that MOH is a problem because the original purpose of taking the offending medications was to relieve or reduce headaches.
Overused medications can be withdrawn either abruptly or gradually. Both approaches can be effective. When withdrawing the medication, it may be helpful to start a preventative medication. Another rescue medication can be used during the withdrawal process. It may take several weeks or up to two months to determine if stopping the overused medication reduces the headaches.