June 2007, Volume 37 Number 6 , p 54 - 54
Towne, Lori M. RN, BSN
QUESTION: A patient came to our ED recently requesting opioids for daily headaches that no longer respond to over-the-counter (OTC) analgesics. What's the best way to manage this kind of pain?
ANSWER: Your patient may be suffering from medication overuse headache (MOH), also known as rebound headache. Many health care providers fail to recognize this chronic headache syndrome, which occurs when a patient overuses OTC or prescription headache remedies to treat recurring tension or migraine headaches. If she takes the remedy daily or near-daily for more than 3 days per week, she can develop MOH. 1
A patient has MOH if she has a headache 15 or more days per month, her headaches have become markedly worse during the period of medication overuse, and the headaches resolve or revert to their previous pattern within 2 months of discontinuing the overused drug. 2,3
The pathophysiology of MOH isn't completely understood, but researchers have several theories. One is central ...