Medication Overuse Headache (MOH) is a chronic daily headache caused by the use of too much acute medication.  It generally occurs in people with migraine or tension-type headaches who take analgesics and anti-migraine drugs too often.  When the effect of one dose wears off, a withdrawal effect occurs, triggering the next headache and another round of medication.  This results in a vicious cycle of daily headaches and increasingly frequent medication intake. MOH was previously called rebound headache, drug-induced headache, and medication-misuse headache.  The most common cause of MOH is overuse of dietary caffeine or caffeine-containing drugs.

MOH is likely to occur if you are taking any of the above medications alone or in combination more than 2 or 3 days each week.

-   Over-the-counter pain medications, such as Tylenol or Advil

-   Over-the-counter combination pain medications containing caffeine, such as Excedrin and Anacin

-   Caffeine and butalbital-containing prescription analgesics, such as Fiorinal, Fioricet, and Esgic

-   Opioids/Narcotics, such as Codeine, Percocet, Vicodin, and Morphine

-   Triptans (Imitrex, Zomig, Maxalt, Amerge, Axert, Frova, Relpax)

-   Ergotamines (Migranal, Cafergot)

If you previously had occasional migraines or tension-type headaches that have gradually increased into a daily (or near-daily) low-grade headache in the setting of frequent medication intake, you probably have MOH.  As the headache frequency increases, you may notice that your acute medications do not work as well as they previously did. 

It is important to recognize MOH because it can worsen your prior headache pattern.  The overuse of acute medications can also decrease the effectiveness of your headache prevention medication.  Other potentially dangerous effects of medication overuse include the development of dependence as well as liver and kidney problems.

The best way of treating MOH is to stop or wean the offending medication under the guidance of your doctor.  Though doing so may result in a period of worsened headaches, you will be given a substitute medication to help you through this time.  In some cases you may be given additional short-term medication to prevent potentially serious withdrawal symptoms.  It may take a month or so before detoxification from the acute medication is complete and your headaches improve.  People who continue to have daily headaches despite stopping overused medications may require daily preventative medications or Botox injections.  Non-drug therapy also plays a role in the treatment of CDH.  Acupuncture, biofeedback, relaxation training and cognitive-behavioral therapy can be very effective, particularly when used in conjunction with medications.  Magnesium, feverfew, coenzyme Q10 and other supplements can also provide significant relief.