Medication Overuse Headaches

Diagnosis

The medication overuse headaches can be diagnosed by a healthcare provider using the criteria of the International Classification of Headache Disorders. The following criteria includes:

• Frequent headaches occurring at least 15 days per month, linked to a pre-existing headache disorder.
• Taking medicine on a regular basis for at least three months to relieve the headaches.
• There isn’t a clearer diagnosis or disease to account for the headaches.

Treatment

The medication overuse headache is treatable. You will need to limit your pain medication in order to stop the cycle of medication overuse headaches. The healthcare provider could advise discontinuing the medication immediately or lowering the dosage gradually.

• Stop the cycle: It’s common for headaches to go worse before getting better when you stop taking medication. Certain medications might cause you to become dependent on them, which can lead to headaches from overusing them. Patient may expect to experience withdrawal symptoms. Typically lasting from 2 to 10 days, these symptoms can endure for several weeks in some cases.
  Treatments for headache pain and medication withdrawal symptoms may be prescribed by your healthcare provider. They refer to this as transitional or bridge treatment. Nonsteroidal anti-inflammatory medications, corticosteroids, and nerve blocks are possible treatment options. Additionally, your healthcare provider may advise getting ergot dihydroergotamine intravenously. Withdrawal headaches typically show improvement within a week or less.
• Hospitalization: It’s sometimes preferable to quit using painkillers in a controlled setting. A brief hospitalization might be advised if you:
  • Have concurrent conditions like depression or anxiety.
  • Are prescribed high dosages of medications containing opiates or the sedative butalbital.
  • Are engaging in substance use, such as tranquilizers, opioids, or barbiturates.
• Preventive medications: You may be able to stop the cycle from medication overuse headaches. To prevent relapsing and to discover a safer method of managing your headaches, work with your healthcare provider. They could recommend a daily preventative medication during or after withdrawal such as
  • An anticonvulsant like topiramate.
  • A tricyclic antidepressant such as amitriptyline or nortriptyline.
  • A beta blocker like propranolol.
  • A calcium channel blocker such as verapamil.

  Your healthcare provider may recommend an injection of a CGRP monoclonal antibody, such as eptinezumab, galcanezumab, fremanezumab, or erenumab, if you have a history of migraines. Monthly injections are available for fremanezumab, galcanezumab, and erenumab. An IV injection of eptinezumab is administered every three months.

  Pain management is possible with these medications without running the risk of medication overuse headaches. If you have headaches again, you might be able to take a medication designed to treat pain. Make sure you take them precisely as directed.

• Injections: OnabotulinumtoxinA (Botox) injections may help you have fewer headaches every month. They could help lessen the intensity of headaches.
• Cognitive behavioral therapy (CBT): This type of therapy provides headache coping mechanisms. Along with working on healthy lifestyle choices, CBT also involves headache diaries.
• Alternative medicine: Alternative or complementary treatments relieve headache discomfort for a large number of people. Not every one of these methods has been researched as a headache treatment. Additional research is required for certain medicines. With a healthcare provider, go over the advantages and disadvantages of alternative treatments. This may includes:
  • Acupuncture: The central nervous system’s inherent painkillers and other chemicals are released with the use of small needles in this traditional procedure. Headaches may be lessened with this treatment.
  • Biofeedback: You can learn to regulate certain physical responses which help in pain reduction through biofeedback. You are connected to monitoring equipment during biofeedback. They provide you with input on physical parameters including blood pressure, heart rate, and muscular tension. After that, you discover how to ease tense muscles, lower your respiration and pulse rate, and calm down. By calming you down, this may make it easier for you to handle discomfort.
  • Supplements: Certain dietary supplements appear to help in the treatment or prevention of specific headache types. However, these claims are not well supported by research. These consist of coenzyme Q10, magnesium, feverfew, and riboflavin, or vitamin B2. Consult your healthcare provider if you’re thinking about using supplements. Certain supplements may cause problems if you also use other medications. Or they might have additional negative consequences.