How can we distinguish MOH from other headaches and Migraines?
Differentiating between a tension-type headache, for example, and MOH can be difficult. There are, however, some very discernable differences between MOH and a Migraine attack. Migraine pain is worsened by activity; MOH tends not to be. MOH is also missing other Migraine symptoms such as nausea, vomiting, phonophobia (sensitivity to sound), photophobia (sensitivity to light), hot flashes, chills, dizziness, and so on.
How do we stop MOH?
Immediately discontinuing the medication causing the MOH is the preferred plan of action. It's obviously the quickest, and it doesn't add more medications to an already confused body. According to Goadsby, et al, withdrawal symptoms usually last two to 10 days. Those symptoms may include: withdrawal headache, vomiting, arterial hypotension, tachycardia, sleep disturbances, restlessness, anxiety, nervousness. In some cases where the MOH is being caused by medications such as butalbital compounds that have been taken daily in large amounts, seizures can occur if the medication is abruptly withdrawn, so a tapered withdrawal or supervised detoxifications is necessary. The best approach is to ask your doctor for help and advice. When you take these medications for pain, you don't become addicted, but you may become dependent upon them. This is a medical issue. Don't be reluctant to discuss it with your doctor. Depending on the medication involved and the situation, some doctors may recommend hospitalization or prescribe medications to help you get out of the MOH cycle.
Will taking pain medications for pain other than head pain cause MOH?
I posed these two questions to Dr. Stewart Tepper of the New England Center for Headache: Does a Migraineur need to be careful about developing MOH from meds taken for pain other than head pain? Is this situation different for Migraineurs and non? His reply was:
Which comes first, chicken or egg? Increased medication use or increased headaches? To answer this question and so assist in establishing causality, we may require reports of patients with episodic migraine who use analgesics or anti-inflammatories for a purpose other than headache and who then developed CDH. Bahra et al reported on 105 patients in a rheumatology clinic who took regular and mixed analgesics and anti-inflammatories for arthritic pain and not for headache. Chronic daily headache was present in 8 (7.6%) of these patients, and all had a history of previous episodic migraine. Regular analgesic use preceded or coincided with onset of CDH in 7 of these 8 patients. No patient lacking a previous history of migraine developed CDH.
Wilkinson et al studied 28 patients who underwent total colectomy for ulcerative colitis; patients with a previous history of CDH were excluded. Eight of the 28 patients used opioids at least 5 days per week. All patients with a previous history of migraine who overused opiates developed CDH, whereas no patient lacking a history of prior migraine who overused opiates did so. While it might be argued that the development of CDH was the cause of, not result of, analgesic overuse, these patients were taking opiates not because of increased headache, but rather to decrease the number of bowel movements. The authors concluded that frequent opiate use could produce CDH in susceptible individuals, and that patients with previous headache had a particular susceptibility to this outcome.
These two small studies suggest that overuse of analgesics, in the absence of increased frequency of headache and for purposes other than the treatment of headache, can result in the precipitation of CDH.
Further, Isler, in 1982, studied 235 patients with CDH between1978-1981. He stated: “Withdrawal of attack drugs alone [i.e. without other rx] led to a marked reduction of frequency of headache, indicating that excessive intake of these drugs is much more a cause than a consequence of frequent and chronic migraine. This conclusion is supported by the observation of relapses of … chronic headache when further administration of analgesics was necessary for other ailments. Of the 87 patients who showed improvement [after detoxification] by a decreased frequency of attacks, 51 had one or more relapses into their former medication habit, always leading to a higher frequency of headache. Their relapses were induced by dental problems and their treatment by analgesics,... [and] by common respiratory infections and their treatment by analgesics."
