Medication-Overuse Headache: clinical and therapeutic problems

The interactions between chronic headache and medication overuse are
complex and not yet fully clarified. In particular, the mechanisms by
which medication overuse takes part in the chronicization process are
still object of hypotheses. Certainly, medication overuse complicates
the therapeutic approaches to chronic headache. Medication overuse
hampers the effect of prophylactic therapies, and only the interruption
of the overuse, over a variable period of time, leads to the disappearance,
or at least the reduction in the frequency of headache. Only at that
point it is possible to start the prophylactic treatment with a wellfounded
probability of success. Unfortunately, interrupting medication
overuse is not an easy task, due to both the severity of the pain symptomatology
and to rebound headache which can compel the patient to
resume medication.
Objectives The aim of our research was to analyze patients with medication-
overuse headache, with respect to the characteristics of drug
medication behaviour and its consequences for headache treatment.
Patients and methods We studied a consecutive series of 50 patients,
newly admitted to the in-patient service of the Headache Centre of the
University of Modena and Reggio Emilia. Data were collected by
means of a questionnaire, specifically prepared for this study, recorded
into a specific database and analysed by SPSS 6.1.2 program, version
for Windows 98.
Results The combination of indomethacin plus caffeine plus prochlorperazine,
and triptans were the medications most frequently overused
by our patients; only a few patients overused ergot preparations. The
majority of patients used the same type of drug daily. All patients
referred they increased the frequency of self-medication because the
headaches were getting worse. For most patients medication overuse
made the headache more endurable, thus allowing them to work or
function more or less normally in daily life. Only a minority experienced
withdrawal symptoms after discontinuation of the medication
overuse. After detoxification, antidepressants were the class of drugs
most used for prophylaxis.
Discussion During chronic use of a medication indicated for acute
treatment of headache, the therapeutic results do not derive solely from
the drug but also from the organism’s adaptation to the repeated use.
This time-process of compensatory adjustments might partly explain
both the chronicization of headache and the withdrawal symptoms
when medication overuse is interrupted.
Conclusion Medication-overuse headache should be prevented because
its management is very difficult. It is necessary to address, at the same
time, both the chronic pain condition and the medication overuse.