Medication Overuse Headache – Diagnosis and Treatment
Diagnosis
Doctors usually use a person’s headache history and their medicine use to figure out if they have medication overuse headache (MOH). Testing is not usually needed. Key points doctors look for include:
- Headaches on at least 15 days each month
- Symptoms lasting over three months
- Frequent use of headache medications
These steps help set MOH apart from other headache types like chronic migraine, tension-type, and cluster headaches.
To confirm the diagnosis, doctors may ask detailed questions about:
- The types of medications being used (such as pain relievers or migraine-specific drugs)
- How often and how long the medications have been taken
- Whether headaches improved when the medications were stopped or reduced
In some cases, doctors may recommend stopping the suspected medication to see if symptoms improve. This process, known as a “withdrawal trial,” can support the diagnosis of MOH.
Once confirmed, a treatment plan can be developed to manage withdrawal symptoms and prevent future overuse.
Treatment
Stopping Pain Medicine Safely
To treat medication overuse headaches, doctors reduce or stop pain medicines like acetaminophen, ibuprofen, aspirin, naproxen, triptans, or opioid analgesics. This process is called withdrawal therapy.
Many people experience withdrawal symptoms such as restlessness, insomnia, nausea, constipation, or increased headache pain after stopping these medications. These feelings may last from several days to a few weeks.
Bridge therapies can help during this time. Doctors might suggest nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, nerve blocks, or anti-nausea medicines.
Medicines like dihydroergotamine, sometimes given through a vein, can also help manage pain as the body adjusts.
Short-Term Hospital Care
Some people need extra support to stop their pain medicines. A brief hospital stay can help, especially for those using high doses of opioid analgesics, tranquilizers, or medicines with barbiturates.
Individuals with severe anxiety, depression, or other health issues may also need hospital-based care for safe management. The hospital team can closely monitor symptoms, manage side effects, and offer support around the clock.
Ongoing Headache Prevention
After the withdrawal process, doctors may recommend preventive medicines to lower the risk of headaches and reduce the need for acute medications. Common preventive treatments include:
- Anticonvulsants: These can help some people experience fewer headaches.
- Tricyclic Antidepressants: Often used to prevent headaches and improve sleep.
- Beta Blockers: Medications that reduce the frequency of migraines.
- Calcium Channel Blockers: Sometimes prescribed to help prevent recurring headaches.
For individuals with frequent migraines, doctors may also recommend injectable monoclonal antibodies that block CGRP (calcitonin gene-related peptide).
These are usually given monthly by injection, although some options may be administered intravenously every few months.
Using Injections for Fewer Headaches
Doctors may use botulinum toxin type A injections for some individuals with chronic headaches. These injections are typically given every few months and can help reduce the number and severity of headaches.
Learning Coping Skills With Counseling
Cognitive behavioral therapy (CBT) teaches ways to deal with pain and stress. CBT can help change negative thought patterns and build healthy habits. Many people also keep a headache diary during therapy to find triggers.
Other Approaches for Headache Relief
Many people look into less traditional options to help manage headache pain. Some methods have more evidence than others, so it is important to talk with a healthcare provider before starting something new.
Acupuncture uses thin needles placed into the skin at certain points. This practice may help trigger the body’s natural pain controls for some individuals.
Biofeedback uses sensors to track body activities like muscle tension, heart rate, and blood pressure. With real-time feedback, people can learn how to relax their muscles and slow their breathing. Over time, this may help reduce pain levels.
Mindfulness meditation guides people to focus on the present. Using special breathing techniques and stress-reducing exercises, mindfulness can help the body and mind feel calmer, which might ease headache symptoms.
Some try herbs, vitamins, or minerals. Common supplements include:
| Supplement | Possible Benefits | Note |
|---|---|---|
| Magnesium | May help prevent headaches | Check with a doctor first |
| Feverfew | Sometimes used for migraines | Research is limited |
| Coenzyme Q10 | May support migraine prevention | Not widely proven |
| Riboflavin (B-2) | May help some people with migraines | Safety varies |
| Melatonin | Sometimes used for sleep-related headaches | Effects differ |
Ways to Manage and Find Help
Connecting with others who experience medication overuse headaches can make a difference. Patients may consider joining local or online support groups to share tips about prevention and tracking symptoms.
Healthcare providers at clinics, including those focused on headaches, often guide patients to resources.
Getting Ready for Your Visit
Steps You Can Take Beforehand
Keeping organized can help make the appointment go smoothly:
Headache Tracking Table
| Date/Time | Symptoms | Triggers | Medicine Taken | How Long It Lasted |
| Example | Throbbing pain | Ate chocolate | Acetaminophen, 325mg | 2 hours |
Create a chart like this to record when headaches happen, their severity, what you ate or did before they started, and any medicine you used.
This log helps identify patterns or triggers and supports the diagnostic process, especially if your symptoms are similar to those listed in the International Classification of Headache Disorders.
Make a list of personal stresses, life events, or recent changes. If you think some symptoms could be warning signs—like sudden, very severe pain, vision loss, weakness, or confusion—write those down too, as these may be “red flag” symptoms.
Prepare a set of questions. Some examples:
- What is causing my headaches?
- Is this a medication overuse headache?
- What is the best way to stop these headaches or avoid them in the future?
- Should we use the International Headache Society’s headache classification to diagnose my symptoms?
- Are there any printed materials or online resources to learn more?
Bring your diary, your questions, and any relevant test results or medication bottles to your visit.
What Your Healthcare Professional Might Ask
Doctors will normally want a clear history and details about your headaches to meet diagnostic criteria. Expect to talk about:
- The type and pattern of your headaches (start date, frequency, location, intensity)
- Recent changes in how your headaches feel
- Severity and what you rate the pain
- All headache medicines used, with details on how often and in what doses
- Changes in how much or how often you use medicine
- If you have had any new or worrisome symptoms, especially neurological ones
- What helps or makes the headache worse
Be honest and thorough, as this information helps your doctor decide if your symptoms match a known type of headache and rule out other causes.
Tips Until Your Appointment
Take only the amount of medicine your healthcare provider recommends. Do not raise your doses or take extra medicine, even if headaches get worse. Focus on healthy habits:
- Get plenty of rest every night.
- Eat regular meals with fruits and vegetables.
- Engage in physical activity as recommended by your healthcare provider.
- Avoid known headache triggers like certain foods or excessive screen time.
- Use your headache diary to record headaches and any medicines you take.
