Medication overuse

Medication overuse headache (MOH) does not respond to steroids according to a new study published in the July 3 issue of journal Neurology. Patients who take Fioricet, Fiorinal, Esgic, Excedrin and other, mostly caffeine-containing drugs often have a headache that is perpetuated by the constant intake of these drugs. This is less likely to happen from triptans, such as Imitrex, Maxalt and Relpax or ibuprofen and acetaminophen. When we try to stop these medications headache usually worsens for several days or weeks before it gets better. We do use corticosteroids (prednisone, dexamethasone, methylprednisolone) to treat not only headaches that result from medication withdrawal but also severe migraines that do not respond to the usual migraine drugs. Corticosteroids are safe when taken occasionally, but can cause many different and often dangerous side effects if taken for long periods of time (weeks and months). We limit the use of corticosteroids to a few days a month.
The editorial which accompanies this report comments on the fact that a previous, larger but less rigorous study found that steroids are beneficial for MOH. The possible reasons for this discrepancy are: 1. the dose of prednsione used in the study was not high enough; 2. corticosteroids are only effective for MOH in patients who suffer from migraines and not tension-type headaches (both were included in this study); and 3. the older and larger study was not blinded and placebo might have played a bigger role.
The bottom line is that because of our positive experience and in the absence of a definitive negative study, we at the NYHC will continue using corticosteroids both for MOH and for other refractory migraine attacks when other treatments (triptans, intravenous magnesium, Botox, etc) fail.

1 comment
  1. Diana says: 10/04/20076:23 am

    My personal experience with MOH from overuse of triptans was that a steriod pack made weaning myself off the culprits slightly more bearable. I’ve luckily not had to do that often, but the two times I did, I was glad to have the help from the steroids to get me through that rough transition.

    I think your points about the results are well taken. My experience was with migraines caused by medication overuse, not tension type headaches, so that may explain the differing results. And it may have been nothing more than placebo effect. It wouldn’t be the first time!

    Somebody Heal Me –

Submit comment