I consistently see medication overuse headache(MOH) conflated and confused with medication overuse(MO); however we want to define MO(say, 11+ days of analgesic use per month, or…11+ days of butalbital/opioid/triptan use per month or….), that does NOT mean that the “overuse” is causing rebound or MOH. Epidemiologic studies to determine MOH are not valid; to say someone suffers from MOH, you need to:1.take a careful history of exactly what happened with the headaches after the drug was started; often this history is not available, and 2. see what happens after stopping the drug, which is never easy(often the analgesic, or triptan, is the only med giving the person any quality of life)….
SO, people are told ‘only take your pain med/triptan/Excedrin 2 days a week”, and the poor patient says “but I have 2 kids, I work, I have headaches 7 days per week, what do I do to survive the other 5 days?”……This “second half of the sentence”, as I like to say, is not answered; the neurologist says “I dunno”….or says nothing…..The problem is, with our “preventive” measures, including the best one, Botox, only about 52% of chronic headache patients achieve long-term relief; SO, what are the other 1/2 of the millions of chronic headache sufferers supposed to do???….
Another common mistake I encounter(3 or 4 times per week, anyway) is patients with depression reflexively given antidepressants, when they are clearly in the “mild end” of the bipolar spectrum; Take your typical scenario: 17y.o. boy, 4 years of anxiety and depression off and on; he is irritable, often quick to anger, mind races at times; + family history of severe depression, substance abuse, anger…..went on Prozac(or Zoloft, or Lexapro or….), and was “up all nite, mind wired, racy”
..This is clearly the mild end of the bipolar spectrum; adding antidepressants to his brain is often like putting gasoline on a fire; we “wire and overcharge” the neurons. We need mood stabilizers in his situation, not antidepressants……But often the main complaint is depression, and antidepressants are given…and often backfire…….
There are a # of reasons for under diagnosing the mild end of the bipolar spectrum; I have written extensively on this. The clinical stakes for missing the diagnosis are enormous……
I can control my almost daily headaches with Rizatriptan. However, Medicare won’t let my pharmacy dispense any more than 36 for 90 days. So, I have to buy more on my own dime. To save some money, I can get away with taking half of a 10 mg tablet. But the headache often comes back later in the day. So the Tylenol/caffeine OTC combo usually works. But what is that doing to my liver? Some days I have no headache at all so I know I am not having MOH. Its nice to see my situation isn’t being blown off to cranky little old lady syndrome!
Yes, let us know what we supposed to do! And also, I was under the impression that one should take pain med/triptan etc. No more than 8 times a week, if I take a triptan amd then, as instructions say, tske another 2 hours later, does that count as “one time” since it’s for the same epispde, or 2x?
And finally I was also under the impression that you could alternate analgesics with triptans or other pain meds so that the total could be 8 times of triptans and X number of anagesics. I had never heard of the 11+ on analgesics.