Dr David PB Watson

Aberdeen

Background InformationCase PresentationGeneral Discussion with Qs and As

8.2 [G44.41 or G44.83] Medication-overuse headache†

A. Headache present on ≥15 days/month fulfilling criteria C and D

B. Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache

C. Headache has developed or markedly worsened during medication overuse

D. Headache resolves or reverts to its previous pattern within 2 months after discontinuation of overused medication

Simple Analgesics 15 days a month

Opiate e.g. codeine 10 days a month

Triptans 10 days a month

Paracetamol 450 mg

Codeine 10 mg Doxylamine Caffeine

Codeine Ibuprofen Caffeine

(headache)

Codeine 12.8 mg Ibuprofen 200mg

Codeine 8 mg Paracetamol 500

mg Buclizine (Pink)

MigraineTension HeadacheCluster (only if migraine tendency)Hemicrania Continua

If taking pain killers for other pain and have migraine can get medication overuse headache

If no headache tendency taking pain killers won’t cause headache

Typical scenarios are More frequent headache e.g. in

perimenopausal period, work stress, insomnia leading to increased painkiller use

New pain condition or worsening pain condition in patient with migraine requiring increased medication

Normal acute and preventer treatments tend to be ineffective

Management relies on withdrawal of overused medication for 8 weeks. “Stopping the Juice!”

Withdrawal should be gradual for opiates and can be abrupt for other medications

Headache can get worse before it gets better

42 year old executive with migraineBusiness trip 4 months ago and

came back with severe migraine and now getting headache every day

Using a triptan every second day, migraleve most days and paracetamol every day

Stopped all medication except paracetamol with no headache relief

39 year old lady with migraine and severe back pain

Using tramadol every day for back pain and triptan and ibuprofen most days for headache

Stopped ibuprofen and triptan and headache a lot better

Stop all the JuiceTreat the worst pain In patients with complex pain

conditions modifying treatment regimes can give benefit