Patient-Centered Treatment of Chronic Migraine With Medication Overuse: More Is Not Always Better

Overuse of acute (e.g., abortive) pain medication is commonly noted in patients with chronic headache disorders, particularly migraine. Whether such overuse is a primary contributor to headache chronification and, more particularly, what the optimal treatment strategies for such patients are remain uncertain.1-4 The traditional view reflected in the International Classification of Headache Disorders (ICHD-3)5 is that most people with chronic headaches have medication overuse headache, the majority of whom will improve on discontinuation of the overused medication, including their responsiveness to preventive medication, and that patients should be cautioned not to exceed dose limitations to prevent the development of chronic headache.

The diagnosis of 8.2 medication-overuse headache is extremely important clinically. Epidemiologic evidence from many countries indicates that more than half of people with headache on 15 or more days/mo have 8.2 medication-overuse headache. Clinical evidence shows that the majority of patients with this disorder improve after discontinuation of the overused medication, as does their responsiveness to preventative treatment. Simple advice on the causes and consequences of 8.2 medication-overuse headache is an essential part of its management and can be provided with success in primary care. An explanatory brochure is often all that is necessary to prevent or discontinue medication overuse. Prevention is especially important in patients prone to frequent headache.5

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