I’m confused and hope you can help clarify a question about Migraine medications and medication overuse headache. Some weeks I only have one Migraine. Other weeks I have four or five. I’ve seen two neurologists. One of them says I can treat every Migraine during the weeks with four or five and avoid medication overuse headache by alternating medications—taking triptans one day and pain pills the next. The other neurologist says that’s incorrect, that I need to limit the number of days I treat Migraines to no more than three days a week. Who is correct?
The second neurologist is correct. Medication overuse headache (MOH) is broken down into subtypes, including this one:
8.2.6 Medication-overuse headache attributed to combination of acute medications Intake of any combination of ergotamine, triptans, analgesics and/or opioids on 10 or more days/month on a regular basis for more than 3 months without overuse of any single class alone.
As you can see, alternating acute Migraine medications such as triptans and pain medications is not adequate to help avoid medication overuse headache.
If you have Migraine attacks on more days than those medications should be used, your doctor may be able to help you with medications without the potential to cause MOH to address some symptoms, such as antiemetics, and muscle relaxants.
Even though you have some weeks with only one Migraine attack, when you consider how many you have in a month, your best option for avoiding medication overuse headache is working with your doctor to find effective preventive treatment, which would reduce your need for acute Migraine treatment.
Thank you for your question,
Dave Watson and Teri Robert
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Do you have questions about Migraine? Reader questions are answered by UCNS certified Migraine and headache specialist Dr. David Watson, and award-winning patient educator and advocate Teri Robert. Questions may be submitted via our submission form. Accepted questions will be answered by publishing the answers in our Ask the Clinician column. For an overview of how we can help and questions we can and can’t answer, please see Seeking Migraine and Headache Diagnoses and Medical Advice.