What is Medication Overuse?
Every medication has its own threshold. When a person has an intake of any acute medication more than the threshold limit, it is referred to as the Medication Overuse.
Different medications have different threshold limit, for example, usage of 3 triptans, alkaloids, combination analgesics or opioids for 10 or more days in a month is referred to as Medication Overuse. Intake of certain simple analgesics, even non-steroidal anti-inflammatory drugs (NSAIDs) for more than 15 days per month is called medication overuse.
What is the Medication Overuse Headache?
The overuse of medications leads to a persisting chronic headache in some individuals. This is known as the Medication Overuse Headache(MOH). Intake of any medications more than the threshold limit might lead to a chronic headache or migraine. Especially the people who are more prone to getting headaches, suffer from MOH(Medications Overuse Headache) very easily.
In the case of the usage of the certain classes of acute medications such as barbiturate-containing analgesics and butalbital, aspirin and caffeine the risk of the chronic migraine increases.
What are the causes of the Medication Overuse Headache?
The Medication Overuse Headache mainly depends on the type of medication being used. Acute medications always have high chances of leading to Medication Overuse Headaches(MOH). Some of the most common medications which can cause the Medication Overuse headache are:
- Simple pain relievers: When the intake of the simple pain relievers such as the aspirin and the acetaminophen(Tylenol, etc) exceeds the recommended daily dosage, it can lead to Medicine Overuse Headache(MOH).
- Migraine Medications:The medications for migraine like triptans (Imitrex, Zomig, others) and certain ergots — such as ergotamine (Ergomar, others), can lead to the Medication Overuse Headaches if used more than the threshold point.
- Opiates:The painkillers which are derived from the opium or synthetic opium compounds are generally a combination of codeine and acetaminophen(Tylenol with Codeine No. 3 and No. 4). These medications when overused can lead to a persisting migraine or a chronic headache which is known as the Medication Overuse Headache(MOH).
- A daily dosage of caffeine from coffee, soda, coke, pain killers, etc also acts as a mild stimulant for the Medicine Overuse Headache.
What are the symptoms of the Medication Overuse Headache?
There are various symptoms which are associated with the MOH(Medication Overuse Headache). The most common symptoms related to it are as follows:
- Persisting and recurrent headaches almost every day.
- Nausea and irritability
- Restlessness and fatigue
- Difficulty in concentrating or loss of concentration
- Memory problems such as forgetting things often
- Depression and anxiety
- Sudden and severe headache accompanied by fever, stiff neck, rashes etc
- Double vision
- Persisting weakness and tiredness
- Difficulty in speaking
- Irregular heartbeat; especially increased rate of the heart.
- Loss of consciousness or frequent fainting
- High blood pressure
- Dizziness and frequent vomiting
When should I go for a MOH(Medication Overuse Headache) Diagnosis?
You should consider consulting your doctor in the following conditions:
– When you are experiencing more than two chronic headaches a week.
– If you have to take pain relievers for more than twice a week, you should consider consulting a doctor.
– If your headache pattern changes, it is definitely suggested t consult it with your heathcare practitioner.
How is the MOH(Medication Overuse Headache) diagnosed?The MOH(Medication Overuse Headache) is diagnosed using various neurological and physical procedures. The neurological procedures focus more on finding the diseases of the brain and nerves which can also lead to severe headaches and migraine. Whereas in the physical tests, the doctor diagnoses the causes via determining the signs and the symptoms of the MOH(Medication Overuse Headache). Some of the most common tests used for the diagnosis of MOH(Medication Overuse Headache) are:
Blood test: A blood test is used for the diagnosis of various health conditions such as diabetes, thyroid problems, infections etc which can cause a headache.
Urine analysis: Several health conditions like various infections, diabetes etc can be determined by using urine analysis procedure. There are various health conditions which can lead to chronic headaches. The urine analysis like the blood test helps in ruling out the causes for the headache.
CT Scan: Computer Tomography(CT) Scan is a method used in which a computerized image of the cross-section of the body is produced by using X-rays and a computer. If you are getting daily headaches, this method is used for ruling out other health conditions which can lead to a persisting and chronic headache.
MRI: Magnetic Resonance Imaging is the method that is used for producing clear pictures or images of the brain without any usage of the X-rays. A large magnet and Radiofrequency(RF) is used for producing a clear image on the computer. If you are getting almost daily or daily headaches, MRI is recommended highly.
Sinus X-Ray: If your symptoms indicate problems related to the sinus, then the doctor might recommend you to undergo the Sinus X-Ray test.
EEG : Electroencephalogram is mainly used as a test method if an individual is experiencing multiple seizures.
Eye test : You can consult an ophthalmologist and get your eye check-up done since an abnormality in the eye pressure can lead to a persisting headache. It also helps in ruling out glaucoma.
Spinal Tap: This is the procedure used for the collection of the CSF(Cerebrospinal Fluid) from the lower back. This procedure helps in determining various infections of the brain or the spinal cord.
What are the treatments available for the MOH(Medication Overuse Headache)?
The treatments for the MOH(Medication Overuse Headache) are elaborated below:
- Breaking The Cycle of the medications
The first step towards curing the MOH(Medication Overuse Headache) is to break the cycle of the intake of the mediations which had been causing the headache. At first, there will be various withdrawal symptoms before it gets better. The most common withdrawal symptoms are as follows:
- Restlessness and anxiety
- Nauseatic feeling
- Often feeling like vomiting
- Sweating of palms and feet
The withdrawal symptoms stay for almost 8 to 10 days generally but they can exist for a few weeks as well.
You might have to get hospitalized for a couple of days if you have the following conditions:
- If you are going through depression and anxiety, a few days of hospitalization is recommended.
- In the case of the high dosage intake of the drugs containing opiates, hospitalization is generally suggested.
- Usage of abusing substances like tranquillizers, opioids or barbiturates
There are various preventive medications which can be used for breaking the cycle of the medication overuse which causes the chronic headache.
The number of headaches experienced per month can also be reduced by using the injection of onabotulinumtoxinA (Botox).
Cognitive behavioural therapy (CBT)
This is talk therapy in which an individual learns the ways to cope with your headache. This treatment also helps a person start and follow a healthy lifestyle.
What are the ways of preventing the MOH(Medication Overuse Headache)?
There are several ways of preventing the MOH(Medication Overuse Headache). Some of the most important preventive measures for the MOH(Medication Overuse Headache) are:
- The medications for the headaches should be taken on time as prescribed.
- Medications containing butalbital or opioids should be avoided.
- OTC(Over The Counter) medications or painkillers should be taken lesser than 15 days a month.
- The usage or the consumption of the triptans or the combination of analgesics should be limited.
- It is a chronic daily headache and a secondary disorder which is caused by the overuse of acute medications.
- The headache prone people have more chances of suffering from MOH(Medication Overuse Headache).
- Using more than two or three analgesics per week can cause a chronic daily headache.
- The people with primary headache disorders like migraine, cluster or tension-type headache are more prone to MOH(Medication Overuse Headache) when they are introduced to non-specific medications.
- Certain classes of medications such as opioids, barbiturate-containing analgesics and butalbital, aspirin and caffeine increase the risk of chronic migraine.
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Dos and Don'ts
- Don’t intake and Butalbitals and Opioids.
- Usage of triptans and combinations of analgesics should not be taken by the individuals who have a tendency
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