Medication Overuse Headache Debated at American Headache Society Meeting
A Chicken & Egg?
Medication overuse headache (MOH) is probably something chronic migraineurs are well-aware of. Basically, it’s when the drugs taken to relieve headache pain paradoxically lead to a worsening of symptoms. There’s no doubt that this issue can be debilitating, but there’s considerable debate as to its scope and impact. Speaking at the American Headache Society’s Scottsdale Headache Symposium, in Scottsdale, AZ, noted German researcher, Dr. Hans-Christopher Diener, noted: “It’s a hen-and-egg dilemma. Does migraine get worse and patients take more medication[s]? Or do patients take more medication and migraine gets worse?” 
The implications of this issue within the headache research and care community are certainly significant. Let’s take a closer look at what we know about MOH and what the sides of this debate are.
A Significant Disorder
The more classic view of MOH is that exact causes aren’t fully understood, and what’s clear is a large, significant portion of chronic migraine sufferers experience it. According to Dr. Diener, 25 to 50 percent of these migraineurs have these headaches.  One of the difficulties here is that this condition occurs with the use of opioid drugs, which are habit-forming and have abuse potential. A growing body of work is documenting and seeking to understand MOH, and some predictive factors have already been laid out. 
What can be done about this condition? Treatment involves a strategic withdrawal from the use of these opioids. “The majority of patients with medication overuse headache revert to episodic migraine after successful treatment,” Dr. Diener noted, adding “[b]ut there is a subroup of patients where you withdraw the medication and the headache doesn’t change.”  This, to him, represents the core challenge of MOH, and the reason it warrants further study and assessment.
Fighting the Gospel of MOH
However, there is no unanimous consensus, and, according to Dr. Elizabeth Loder of the Harvard Medical School, the standard approach and understanding of the condition has become a “gospel of medication overuse headache” rather than an assessment of the evidence. Basically, she believes that, while MOH is certainly a real condition, it’s “over-emphasized and the evidence in support of these concepts is quite weak.” 
What’s lacking for Dr. Loder? First off, she points to the fact that not all MOH cases go away when migraineurs stop taking medications. This implies that the pathways by which opioid drugs kill pain may not actually be the problem. Furthermore, most studies on the subject are observational and rely on an arbitrary and unsettled definition of what actually constitutes this kind of headache. “Even if medication overuse exists, there must be a spectrum of susceptibility,” she added. 
The Research Consensus
What she wants to see is likely what everyone involved in the debate wants: more clinical studies that employ control groups to truly observe and study MOH. As Dr. Loder has it, telling patients not to use pain killing drugs might, in itself, cause “unnecessary suffering.” The implication for treatment is pretty clear: “It’s probably time to take a more neutral view of medication overuse,” she says, “patients and physicians should recognize that we cannot tell with certainty how much medication is too much.” 
It will take further work to get to the bottom of MOH, but the good news is that, unlike in other arenas, all concerned parties here are invested in getting to the truth. No doubt, then, debate like this represents a healthy level of skepticism and critical acumen.
Whether the result of MOH or migraine, headache and other symptoms can be truly debilitating. And the good news is that methods and treatments nowadays are better than they’ve ever been. Our understanding of this difficult condition is growing, and with it, the tools we have to take it on. The point being: There’s no reason to take a back seat to migraine. Get in the drivers’ seat and take the wheel; get the help you need.
If you suffer from chronic migraine—cases in which attacks are occurring 14 or more times a month—the team at Migraine Treatment Centers of America is ready to help. Employing the groundbreaking Omega Procedure—a drug-free approach—they’ve helped countless patients achieve real relief from the condition. Learn more about what they do by calling 469-638-0207 today!
- Judy George. 2018. “Medication Overuse Headache: Is It Overblown?”. Com. Accessed December 15 2018. https://www.medpagetoday.com/meetingcoverage/ahs/76467.
- Schwedt, Todd J., Aftab Alam, Michael L. Reed, Kristina M. Fanning, Sagar Munjal, Dawn C. Buse, David W. Dodick, and Richard B. Lipton. 2018. “Factors Associated With Acute Medication Overuse In People With Migraine: Results From The 2017 Migraine In America Symptoms And Treatment (MAST) Study”. The Journal Of Headache And Pain 19 (1). Springer Nature. doi:10.1186/s10194-018-0865-z.