There is a critical need to review current treatment strategies for the increasingly common problem of medication overuse headaches (MOH), according to a series of international papers in the November issue of Cephalalgia .
"MOH is associated with severe disability, unmet treatment need and little clinical data to support current management strategies" says neurology expert Professor David W Dodick from the Mayo Clinic College of Medicine, Arizona, USA.
His overview also highlights the need for greater research into the condition - in particular the role that migraine medication can play in the withdrawal process. It is accompanied by papers on how the condition is tackled in Canada, Denmark, Germany, India, Moldova, Japan, Spain and Taiwan.
MOH, previously known as rebound headache, drug-induced headache or drug-misuse headache, is a headache that occurs at least 15 days a month when patients overuse medication.
"Tolerance to the analgesic effect of the acute medication develops over time, consumption may increase and patients may show withdrawal symptoms when they stop the overused mediation" explains Professor Dodick. "We estimate that the condition affects one in every 100 adults and one in every 200 adolescents worldwide, which is a considerable number.
"For example, in the USA 60 per cent of people with chronic daily headaches attending headache clinics have MOH. Data from a physician study suggests that it may be the third most frequent type of headache after migraines and tension-type headaches. And a Norwegian study found that people were seven times more likely to suffer from chronic headaches if they used analgesics daily or almost daily for more than a month."
Despite being very common, there are no standardised treatment guidelines for MOH, partly due to the small number of controlled clinical trials that have addressed the treatment of this condition.
However, recent research suggests that the traditional approach of not providing new treatment strategies until patients have been through detoxification may not be the best clinical option.
"Data from recent trials indicate that treatments developed to prevent migraine may prove effective if they are used in patients with MOH before the overused medicine is withdrawn" says Professor Dodick.
"This points to the need for clinical trials to re-evaluate current strategies and find the best way forward."
The international papers that accompany Dr Dodick's overview show that MOH is a common problem, but the incidence, causes and treatment vary from country to country.
"It is clear from the papers in this issue of Cephalalgia that MOH is a common universal problem and that many countries face unique challenges due to the drugs that are available, patient and physician attitudes and the different health care delivery systems" says Dr Dodick, who will take over as Editor-in-Chief of Cephalalgia in January 2009.
"However, the overwhelming consensus is that MOH is a growing problem that has a major negative impact on health-related quality of life. It is important to identify patients with a high frequency of headaches, who are at high risk of MOH, as early as possible and initiate measures to reduce the consumption of acute pain medication.
"This is an important series of papers as it illustrates the global public health burden imposed by MOH and identifies the unique underlying factors that contribute to MOH in different countries, as well as country-specific barriers to treatment.
"The expert authors have also highlighted the need for systematic and concerted research efforts to better understand the mechanisms and most effective treatment strategies for MOH, stressing that this is a major priority in the field of headache medicine."
Notes to editors
How clinicians can detect, prevent and treat medication overuse headache. Dodick et al. Cephalalgia . 28.11, p1207-1217 (November 2008). Country papers: Canada (Becker et al, p1218-1220). Germany (Katsarava et al, p1221-1222). India (Ravishankar et al, p1223-1226). Japan (Kanki et al, p1227-1228). Moldova (Moldovanu et al, p1229-1233). Spain (Pascual et al, p1234-1236). Scandinavia (Jensen et al. p1240-1242). Taiwan (Wang et al. p1218-1220)
Cephalalgia is published by Wiley-Blackwell on behalf of the International Headache Society. Edited by Professor Peter Goadsby, from the Institute of Neurology, London, it contains original research papers, review articles and short communications on all aspects of headache. www.blackwell-synergy.com/loi/CHA
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