The Medication-Overuse Headache – a Preventable Problem

The medication-overuse headache (referred to hereafter as ‘MOH’) has been well-known for a relatively long time. It was first described as an independent phenomenon in 1951. It always occurs in connection with migraine or tension-type headache and develops through the overuse of painkillers over a period of more than three months. This overuse happens when patients take pain medication on more than 10 days in a month and continue to do so over a period of more than three months. Around 90% of those affected have this kind of history with headaches; it practically never affects people with no pre-existing conditions, even when they take pain medication due to other symptoms. A MOH is when the medication overuse described above triggers headaches on at least 15 days per month. The good news: MOH can be avoided by taking preventative measures. But more on this later.
Von einem MÜK spricht man, wenn der beschriebene Übergebrauch der Medikamente an mindestens 15 Tagen pro Monat Kopfschmerz auslöst. Die gute Nachricht: MÜK lässt sich durch Vorbeugungsmaßnahmen vermeiden. Doch dazu später mehr.

How often does MOH occur?

Although there are many studies, estimates on the frequency of MOH differ. According to one study on the Global Burden of Disease, which is regularly published in the renowned medical journal “The Lancet”, around 1-2% of the general population are affected. This means that between 50 and 100 million adults suffer from MOH worldwide. Women are affected two to three times as much as men. Additionally, the illness seems to occur to a very different extent in different professional groups. For example, more detailed studies show that this problem is significantly more widespread in healthcare and nursing.

How does MOH develop?

The connection between the frequent intake of headache medication and the development of MOH is scientifically well-substantiated. However, the exact process of its development has not yet been sufficiently explained.

Today, it is assumed that the body’s signalling and messenger substances which are responsible for the transmission and processing of pain stimuli have a role to play. Their function and mode of operation is altered through excessive medication intake. If this intake persists, then pain control will be affected. Sensitivity to pain increases and headache attacks become more frequent and more severe. In this way, the medication is actually causing what it should have been preventing: excruciating headaches.

Effects on the brain

Through imaging techniques, it was demonstrated that there are changes in the condition of particular areas of the brain among patients affected by MOH. Scientists associate these with altered pain processing. Moreover, noticeable abnormalities were also found in the brain’s metabolism. As a result, it was established that the number of available transport molecules for the important messenger substance dopamine was reduced in the areas of the brain which had been examined. From this, the scientists concluded that the brain’s signal transmission is affected by this shortage. This could be important in the development of MOH.

The observation that several of the identified changes reversed themselves, once the excessive medication intake had stopped, was of particular interest. However, this does not seem to be the case for all the metabolic pathways which are affected by pain medication. For example, a disrupted glucose balance could not be returned to its normal level by ending medication intake. Intact, well-functioning glucose processing is therefore particularly crucial for preventing headaches.

Medication intake: always keep in mind the 10-20 rule

The most effective way of preventing an MOH is keeping to the so-called 10-20 rule. This states that painkillers can be taken on a maximum of 10 days per month, and that affected people should avoid taking this kind of medication altogether on at least 20 days per month. The amount and the dosage are irrelevant for this intake rule, as the number of “medication days” is what counts. The Prevent Headache app is especially helpful for this. It includes a medication tracker which warns users when their medication intake has reached a critical level. This can help you to stick to the 10-20 rule.

What can be done to help?

However, if an MOH has developed, a medication break should be implemented as the most effective measure, accompanied by comprehensive medical support. Countless studies give the same recommendation, which can be summarised by the umbrella term: “drug holidays”. In essence, the purpose of these is to remove the nervous system’s almost constant supply of painkillers and to refrain entirely from taking them for a specified period of time. Given that medication is what has originally caused the disruption of pain perception, its complete removal is seen as the only effective measure. Only by doing this do we give the pain regulatory system the chance to gain back control over pain occurrences. This sounds like classic drug withdrawal, and indeed works in a similar way. The central misalignment can be rectified in this way. As a result, the frequency and severity of attacks will go down, as could be demonstrated in numerous studies.

Any withdrawal of this kind should be accompanied by behavioural measures if it is to be successful in the long term. It is therefore recommended that this difficult phase be carried out with support from a doctor. In addition, giving patients detailed information is an important foundation for preventing and treating MOH. It helps to create an understanding of cause and effect with regards to pain occurrences.

Prevention is the most important remedy

If you want to prevent the MOH, keeping to the 10-20 rule is the best method. If it is consistently followed, MOH can be avoided altogether. This leads to a noticeable improvement in quality of life, meaning that those affected have a strong motivation to stay committed long-term. It is well-documented that changing your behaviour to follow the 10-20 rule when taking painkillers has a positive effect on patients’ overall wellbeing for years to come. Equipped with this certainty, you have a good chance of successfully preventing and permanently overcoming the MOH.

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