Too Much of a Good Thing? The Dangers of Medication Overuse Headache in Migraine

January 24, 2018

Benefits vs. Costs

Since there’s rarely a silver bullet when it comes to migraine management, treatment involves trying a range of different approaches in consultation with medical staff. It’s more of a road than a specific destination. Migraineurs may find it helpful to track (and avoid) their triggers; in more extreme cases they may opt for surgery; and, there is a variety pharmaceutical medications that can be prescribed. With regards to the latter, drugs can be classified into those that are more preventative and those that take on headache and other symptoms after the fact.

Interestingly, though, the efficacy of pills in treating migraine can vary over time. It may take a month or so before a specific drug starts working at all, and, in other cases, a prescription will become less able to take on symptoms. On top of that, a danger arises for those that suffer from more frequent attacks: their medications stop working due to overuse and can even make symptoms worse. [1] This condition, called medication overuse headache (MOH), can occur with every class of migraine medication, and it’s a tricky problem for both patients and doctors.

Use vs. Overuse

MOH is considered a “secondary condition” and is defined as headache that occurs on 15 or more days a month in a sufferer who has been overusing medications for 90 or more days. [2] What gets tricky is that each type of drug used to treat migraine acts differently, so the definition of “overuse” can vary. Here’s a quick breakdown: [1]

  • Ergotamines: This type of drug is more preventative in nature, and it works by stopping blood vessels in the brain from dilating and expanding. Overuse is defined using this 10 or more days a month for three months.
  • Triptans: A class of medication designed to take on attacks as they strike, triptans stimulate serotonin, a brain chemical, to reduce inflammation and dilation of blood vessels. As with ergotamines, MOH can occur if they’re taken more than 10 days a month.
  • Analgesics: These are drugs that you’ll likely be familiar with: Aspirin, Ibuprofen, and acetominophen among others. They’re typically a first line treatment for headache pain. Overuse occurs when these are taken more than 15 days a month for three or more months.
  • Opioids: Prescription pain killing medications like Vicodin, Percocet, and Oxycontin make up this class. As effective as they can be in mitigating pain, overuse of this class of drugs—defined as taking them 10 or more days a month for three or more months—is particularly dangerous because they’re addictive and can lead to relapsed use.

In addition, it’s important to note that these drugs are often taken in combination with each other, which can lead to sub-types of MOH. Typically, doctors recommend that patients limit use of these medications to 2-3 times a week.

Seeking Solutions

The best way to take on MOH, of course, is to ensure that patients stop taking the medication or medications in question. This is difficult because other approaches need to be taken on, so doctors may need to supplant problematic prescriptions with others.  Oftentimes, the patient will need to taper off use. It’s an extended process, and the transition can be challenging.

What should you do if you think you’re suffering with MOH or if medications aren’t working? Here are a couple tips:

  • Monitor Intake Closely:

    In the struggle against migraine, information is your best weapon. Track the drugs you’re taking, as well as symptoms, frequency of headaches, and triggers. This gives you a better sense of how well medications are working.

  • Prevention:

    You may be able to reduce use of medications by figuring out ways to prevent migraine attacks from forming in the first place. This might involve avoiding certain foods or drinks, figuring out means of coping with stress, and ensuring better sleep patterns.

  • Communication:

    It’s essential that you’re open and communicative with your doctor; if you’re concerned about developing MOH, you may want to ask about “rescue medications,” which are alternatives that work when current pills aren’t effective.

  • Other Therapies:

    Medicating migraine isn’t the only option. Sufferers of chronic migraine—when attacks occur more than 14 days a month—may want to consider surgical approaches like the Omega Procedure.

Though MOH is not a common condition, it’s something to be aware of and avoid if possible. In the end, what you’ll need is to be responsive and adaptable. What worked months ago may not tomorrow, but there’s no doubt that your efforts will pay off. A life free of the cloud of migraine is worth fighting for.

If you’re struggling with migraine, the dedicated experts at Migraine Treatment Centers of America are ready to help. In fact, by employing the latest in techniques and technologies, they’ve helped countless people effectively manage their condition. Learn more by calling a Patient Care Manager there at (855) 300-6822 today!


  1. Robert, Teri. 2011. “Help! How Can I Not Overuse Migraine Medications?”. Com.
  2. “Medication Overuse Headache – American Migraine Foundation”. 2017. American Migraine Foundation. Accessed August 23 2017.

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