Scher AI, Rizzoli PB, Loder EW. Medication overuse headache:
An entrenched idea in need of scrutiny. Neurology. 2017 Sep
19;89(12):1296-1304.
Abstract
It is a widely accepted idea that medications taken to
relieve acute headache pain can paradoxically worsen headache if used too
often. This type of secondary headache is referred to as medication overuse
headache (MOH); previously used terms include rebound headache and drug-induced
headache. In the absence of consensus about the duration of use, amount, and
type of medication needed to cause MOH, the default position is conservative. A
common recommendation is to limit treatment to no more than 10 or 15 days per
month (depending on medication type) to prevent headache frequency progression.
Medication withdrawal is often recommended as a first step in treatment of
patients with very frequent headaches. Existing evidence, however, does not
provide a strong basis for such causal claims about the relationship between
medication use and frequent headache. Observational studies linking treatment
patterns with headache frequency are by their nature confounded by indication.
Medication withdrawal studies have mostly been uncontrolled and often have high
dropout rates. Evaluation of this evidence suggests that only a minority of
patients required to limit the use of symptomatic medication may benefit from
treatment limitation. Similarly, only a minority of patients deemed to be
overusing medications may benefit from withdrawal. These findings raise serious
questions about the value of withholding or withdrawing symptom-relieving
medications from people with frequent headaches solely to prevent or treat MOH.
The benefits of doing so are smaller, and the harms larger, than currently
recognized. The concept of MOH should be viewed with more skepticism. Until the
evidence is better, we should avoid dogmatism about the use of symptomatic
medication. Frequent use of symptom-relieving headache medications should be
viewed more neutrally, as an indicator of poorly controlled headaches, and not
invariably a cause.
Courtesy of https://www.doximity.com/doc_news/v2/entries/8892160
No comments:
Post a Comment