What Drugs are Associated with the Development of Medication Overuse Headache (MOH)?

Bernard M. Abrams, MD

For healthcare professionals who treat headaches, medication overuse headache (MOH) has been a perplexing issue for some time. While a large amount of anecdotal evidence exists, the type of drug, length of administration and percentage of suffers developing MOH remains largely unknown. This study was composed of two parts. Part 1 consisted of a screening phase and written questionnaires were mailed to 120,000 US households.

The authors identified 30,721 respondents that reported experiencing at least one severe headache during the past year. These respondents were defined as “headache sufferers.” Part 2 was a five-year longitudinal study of a random sample of 24,000 of these headache sufferers. They were sent written questionnaires in 2005 detailing the characteristics of their headaches, types and quantities of abortive medications consumed, and comorbid medical disorders.

The overall rate of transformation from episodic to chronic migraine was 2.5% per year. Adjusted analyses demonstrated that any use of barbiturate compounds and opiates in 2005 was associated with an increased risk of transformation to chronic migraine in 2006 (barbiturate compounds: OR, 1.73; 95% CI, 1.10, 2.73; opiates: OR, 1.44; 95% CI, 1.10, 2.08) compared with acetaminophen.

Triptans, nonsteroidal medications (NSAIDs), and isometheptene compounds were not associated with an increased riskAn increase in the number of days of exposure to barbiturate compounds led to a greater likelihood of developing transformed migraine (OR, 1.25; 95% CI, 1.13, 1.38). The authors concluded that the use of opiates and barbiturates at any frequency was associated with higher rates of transformation to chronic migraine.

Clear dose-response relationships between frequency of use and transformation were only seen with butalbital compounds and NSAIDs. Higher frequency of the use of butalbital-containing compounds increased risk for transformation, whereas higher frequencies of the use of NSAIDs decreased risk, particularly in those with low to intermediate baseline headache frequencies.

For those who treat chronic headache sufferers, this article is highly recommended.

Bigal ME, Serrano D, Buse D, et al.: Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study.

Headache 2008, 48:1157–1168