Secondary Headaches » Medication Overuse Headache

Patients with a pre-existing primary headache who in association with medication overuse develop a new type of headache or a marked worsening of their pre-existing headache that, in either case, meets the criteria for 8.2 Medication-overuse headache (or one of its subtypes) should be given both this diagnosis and the diagnosis of the pre-existing headache. Patients who meet criteria for both 1.3 Chronic migraine and 8.2 Medication-overuse headache should be given both diagnoses.

Description:

Headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more or 15 or more days per month, depending on the medication) for more than three months. It usually, but not invariably, resolves after the overuse is stopped.

General comment:

In the criteria set out below for the various subtypes, the specified numbers of days of medication use considered to constitute overuse are based on expert opinion rather than on formal evidence.

Diagnostic criteria:

A. Headache occurring on ≥15 days per month in a patient with a pre-existing headache disorder
B. Regular overuse for >3 months of one or more drugs that can be taken for acute and/or symptomatic treatment of headache

Subtypes:

1. Ergotamine-overuse headache – Regular intake of ergotamine on ≥10 days per month for >3 months
2. Triptan-overuse headache – Regular intake of one or more triptans, in any formulation, on ≥10 days per month for >3 months.
3. Simple analgesic-overuse headache
   1. Paracetamol (acetaminophen)-overuse headache – Regular intake of paracetamol on ≥15 days per month for >3 months.
   2. Acetylsalicylic acid-overuse headache – Regular intake of acetylsalicylic acid (aspirin) on ≥15 days per month for >3 months.
   3. Other non-steroidal anti-inflammatory drug (NSAID)-overuse headache – Regular intake of one or more NSAIDs other than acetylsalicylic acid on ≥15 days per month for >3 months.
4. Opioid-overuse headache – Regular intake of one or more opioids on ≥10 days per month for >3 months.
5. Combination-analgesic-overuse headache – Regular intake of one or more combination-analgesic medications on ≥10 days/month for >3 months.
6. Medication-overuse headache attributed to multiple drug classes not individually overused – Regular intake of any combination of ergotamine, triptans, simple analgesics, NSAIDs and/or opioids on a total of ≥10 days per month for >3 months without overuse of any single drug or drug class alone.
7. Medication-overuse headache attributed to unverified overuse of multiple drug classes – Both of the following: a) regular intake of any combination of ergotamine, triptans, simple analgesics, NSAIDs and/or opioids on ≥10 days per month for >3 months and b) the identity, quantity and/or pattern of use or overuse of these classes of drug cannot be reliably established.
8. Medication-overuse headache attributed to other medication – Regular overuse, on ≥10 days per month for >3 months, of one or more medications other than those described above, taken for acute or symptomatic treatment of headache.

Source

Headache Classification Committee of the International Headache Society (IHS) (2013). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33: 9-807.