Is Medication Overuse Drug Specific or Not? Data from a Review of Published Literature and from an Original Study on Italian MOH Patients

Licia Grazzi, Eleonora Grignani, Domenico D’Amico, Emanuela Sansone, Alberto Raggi

Research output: Contribution to journalReview articlepeer-review

Abstract

Purpose of Review: The aim is twofold. First, to give an insight on the role exerted by different classes of drugs in favouring migraine chronification. Second, to explore the relationship between type and amount of overused medications and history of previous withdrawal treatment and of frequent relapses. Recent Findings: All drug classes were found to favour migraine chronification. No data are available for the association with relapses into CM-MOH. Our clinical study shows that patients who underwent previous withdrawal treatments were more likely to be overusers of multiple drug classes and overuse higher amounts of symptomatic medications, particularly, indomethacin, eletriptan and tramadol. Frequent relapsers were more likely to be overusers of opioids or ergotamine and caffeine derivates or of multiple classes, particularly acetylsalicylic acid and ergotamine/caffeine derivates. Summary: The joint results our review and clinical study do not seem to support the idea that MOH is drug-specific: rather, it points out that all drug classes may induce migraine chronification. Those drugs which are at higher risk of overuse are among those preferred by the “worst” patients, i.e. those who needed one or more withdrawal treatments for MOH. Our results reinforce the clinical impression that patients with CM and MOH, and particularly the most difficult to treat for their poor response to withdrawal treatments, are characterised by a particular drive towards the consumption of “whatever is likely to be perceived to provide some relief”, despite these drugs that are perceived as “more powerful”, are often indicated as second- or third-line medications.

Original languageEnglish
Article number71
JournalCurrent Pain and Headache Reports
Volume22
Issue number11
DOIs
Publication statusPublished - Nov 1 2018

Keywords

  • Anti-inflammatory drugs
  • Chronic migraine
  • Medication-overuse headache
  • Opioids
  • Triptans
  • Withdrawal

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

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