STEP2: Headache and Migraine Flashcards
(21 cards)
What is Medication-overuse headache (MOH)?
A chronic secondary headache disorder caused by regular overuse of analgesics used to treat a preexisting chronic headache disorder.
What are the most common underlying headache disorders associated with MOH?
- Migraine
- Tension-type headache
Which medications are most commonly overused leading to MOH?
- Simple analgesics (e.g., acetaminophen, NSAIDs)
- Combination with caffeine
- Triptans
Which demographic is most commonly affected by MOH?
Women aged 40–49 years.
What are the key factors involved in the pathophysiology of MOH?
- Dependence processes
- Central sensitization
- Possibly genetic predisposition
How is the diagnosis of MOH primarily established?
Based on clinical criteria.
Are diagnostic studies usually necessary for diagnosing MOH?
No, unless indicated to investigate the cause of the preexisting chronic headache.
What are the main treatment strategies for MOH?
- Patient education
- Weaning of overused medications
- Management of withdrawal symptoms
- Relapse prevention
What happens to MOH typically after discontinuation of overused medications?
It typically resolves.
What is the estimated prevalence of MOH in the general population?
Around 2%.
What risk factors are associated with MOH?
- Preexisting chronic headache disorder
- Prolonged overuse of symptomatic headache medications
- Female sex
- Smoking
- Physical inactivity
- Regular use of tranquilizers
What are the clinical features of MOH?
- Increase in headache frequency and severity
- Increasing refractoriness to abortive and prophylactic pain medications
- Migraine or tension-like quality
- Change in type and location of pain
- Worse pain in the morning
- Associated neck and sinus pain
- Autonomic and vasomotor symptoms
- Comorbid anxiety and depression
What is a diagnosis of exclusion in the context of MOH?
MOH should be considered after ruling out other headache disorders.
What are general principles in managing MOH?
- Patient counseling
- Complete weaning of overused medication
- Avoid headache medications during the withdrawal period
What supportive interventions may be included in the treatment of MOH?
- Rescue medications for withdrawal symptoms
- Short-term bridging medications
- Nonpharmacological interventions
- Long-term prophylactic medications
What are common withdrawal symptoms from overused medications?
- Worsening headache
- Nausea/vomiting
- Tachycardia
- Hypotension
- Anxiety, restlessness
- Sleep disturbance
What lifestyle changes may help in managing MOH?
- Trigger avoidance
- Nonpharmacological therapies (e.g., relaxation techniques, cognitive behavioral therapy)
What are primary prevention strategies for MOH?
- Identify at-risk patients
- Educate on risk of MOH
- Optimize abortive and preventive management
- Address modifiable risk factors
What should be limited to prevent recurrence of MOH?
Use of headache symptomatic medications to no more than 2 days per week.
Fill in the blank: The primary underlying chronic headache disorder associated with MOH is _______.
[migraine]
