Painkiller headache

Drug-induced chronic daily headache (CDH), or as Isler1,2⇓ has termed it, “painkiller headache,” has been reported since the 17th century and reached epidemic proportions in Switzerland after World War II. Repopularized in 1951 by Peters and Horton, medication overuse headache (MOH, formerly drug-induced headache) became a well-characterized disorder1,3⇓ and is a growing problem all over the world. Population-based studies report the prevalence rate of MOH to be 1 to 2%.4,5⇓ In European headache centers, 5 to 10% of the patients have MOH. One series of 3,000 consecutive headache patients reported that 4.3% had MOH.6 In American specialty headache clinics, the majority of patients who present with CDH overuse acute medication.1,2,4,7⇓⇓⇓

Patients with frequent headaches often overuse opioids, analgesics, ergotamine, and triptans. Medication overuse frequently produces CDH (previously drug-induced rebound headache) accompanied by dependence on symptomatic medication and refractoriness to preventive medication.1 In subspecialty centers, most patients with MOH are women who have a history of episodic migraine that has been converted to chronic (transformed) migraine as a result of medication overuse. The headaches grow more frequent (over months to years) and the associated symptoms of photophobia, phonophobia, and nausea become less severe and less frequent than during typical migraine. Stopping the overused medication frequently results in headache improvement, although this may take days or weeks to occur.8,9⇓ Many patients remain improved after detoxification. In population studies, less than one-third of CDH patients overuse medication.4,7⇓ Thus, medication overuse is not necessary for the development of CDH. Patients with episodic tension-type headache may also overuse acute medications and develop daily headaches. In …