How do we stop MOH?
Immediately discontinuing the medication causing the MOH is the preferred plan of action for most medications. 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. Other experts in the field have written that it can take weeks, a month, or even longer to end the MOH. cycle.
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as butalbital compounds that have been taken daily in large amounts, seizures can occur if the medication is abruptly withdrawn, so a tapered withdrawal or supervised detoxifications is necessary.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?
For someone who already has Migraine disease or another headache disorder, yes.
Comments from Migraine and headache experts:
I asked some Migraine and headache experts for comments on MOH. Here are those comments:
"MOH continues to be a vexing problem in tertiary care centers and a major challenge to primary care physicians with these patients often requiring referrals to specialists. AMPP data demonstrates that butalbital and opiates are the 2 agents most likely to lead to overuse and are a major risk factor in the genesis of CDH. Transitioning patients from MOH (10 or more days of combination products, opiates, triptans or 15 or more days of single ingredient OTCs) can be difficult as patients get worse before they improve. Pharmacologic treatment, preventives and behavioral therapies are often required. 80% will improve with a 50% or more decrease in frequency and intensity. Failure to address MOH will likely reduce the potential efficacy of any preventive intervention. Kudrow was the first to point this out in a landmark prospective study more than 30 years ago. Many studies since that time have shown similar results." ~ Dr. Fred Sheftell2
"Medication overuse headache is viewed by the International Classification of Headache Disorders, as a secondary headache disorder, as headache attributable to medication taking. In my opinion, it is better considered a complication of primary headache, usually a complication of migraine." ~Dr. Richard B. Lipton3
"MOH is usually a complication of Migraine or another headache disorder, a complication that can present huge obstacles to headache treatment. It not only makes it less likely that prophylactic (preventive) medications will work; it can reduce the effectiveness of IV infusions for intractable Migraine and headaches. Unfortunately, well-intentioned clinicians with little knowledge about treating headache disorders too often enable MOH by prescribing opioids or recommending short-acting over-the-counter analgesics as a primary treatment, and this backfires or leads to a situation where there is more headache, not less." ~Dr. John Claude Krusz4
