Nearly Daily Use of Naproxen Sodium and Medication Overuse Headache?

Health Professional


Will taking naproxen sodium nearly daily cause medication overuse headache? I have had two treatments with Botox, take verapamil 240 mg daily for migraine prevention, and take rizatriptan no more than twice a week. I have headache daily, with varying severity. Thank you, Debbie.


Dear Debbie;

Yes, taking naproxen sodium nearly daily can cause medication overuse headache (MOH). There is a bit of confusion about nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen sodium. NSAIDs have been shown to be protective against transition to chronic migraine at low to moderate monthly headache days (10 - 14 days a month), but were associated with increased risk of transition to chronic migraine at** high** levels of monthly headache days (15 or more days a month). This would serve to confirm that NSAID use should be restricted to no more than two or three days per week and should NOT be used for migraine prevention.

Another element of MOH is that, in order to avoid MOH, we need to count the total number of days per week that we use any acute medications and limit them to two or three days a week. Since you mentioned rizatriptan and naproxen sodium, let's take them as an example. If you used rizatriptan on Monday and Wednesday and naproxen sodium on Tuesday and Thursday, that would be a total of four days. That's important because of this subtype of MOH outlined in the International Headache Society's International Classification of Headache Disorders, Third Edition (ICHD-3):

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 three months without overuse of any single class alone.

For more information about medication overuse headache, check out:

Thank you for your question,
Dave Watson and Teri Robert


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