Treatment of medication-overuse headache (MOH)

What is medication-overuse headache?

MOH is an aggravation of your usual headache caused by taking medication for headaches or other pain too frequently over a period of at least 3 months. All types of acute pain medication can trigger MOH, even if taken for a type of pain other than a headache. This condition affects a large proportion of people who suffer from frequent headaches, and there is extensive experience in improving the condition with the right treatment.

There is a risk of developing MOH if you have taken the following painkillers for 3 months:

• Migraine medication for more than 9 days a month (triptans)
• Over-the-counter medication for more than 14 days a month (paracetamol, ibuprofen, etc.)
• Morphine/combination preparations for more than 9 days a month (Dolol, Treo, Kodimagnyl, etc.)
• A combination of the above types of medication for more than 9 days a month in total

What are the symptoms of medication-overuse headache?

You experience more frequent and intense headaches. The medication becomes less effective. If you suffer from several types of headaches, they may be harder to distinguish from one another.

You may have a headache, nausea, and feel unwell or heavy-headed when you wake up in the morning. This subsides once you have taken your first pills. You may also feel that you can cope with or manage less than before, and that your quality of life has diminished.

What is the treatment for medication-overuse headache?

The treatment for MOH is medication withdrawal, meaning no painkillers for two months, neither for headaches nor for other pain conditions. The purpose of this break is to make your headache responsive to treatment again by breaking the vicious cycle of increasing headaches and growing medication consumption. Many people experience a general improvement in well-being after some time.

If you take medication for asthma, heart disease, or other conditions, you must, of course, continue to take it. Your doctor or nurse will discuss with you which medications you should continue and which you should pause for the two months.

What can you expect?

During the first few weeks, you may find that your headache gets worse. You may also experience flu-like symptoms or sleep problems. When stopping morphine-like medication, you may experience diarrhea, fever, palpitations, sweating, and restlessness in your body and legs.

For some, the headache continues unchanged, and for a very few, the headache may worsen. Most often, however, the symptoms subside over a few weeks, and the headache decreases in frequency and intensity. Some also feel more energetic when they are not taking medication regularly.

It can be a good idea to prepare for the medication withdrawal:

• Decide on a date to stop taking headache medication. You may want to remove the medication from your home
• Tell family and friends that you are going through a period without medication, and what they can and cannot expect from you – perhaps they can also support you
• Limit your commitments and appointments during this period
• Consider taking sick leave or partial sick leave – you may want to talk to your employer about it

Pain relief without medication

• Try doing the things that usually help (other than medication) when you have a headache
• Ensure peace and rest, and make time to take care of your headache
• Apply something cold or warm to your head. This may help relieve the pain
• Maintain a healthy lifestyle: plenty of fluids, regular and healthy meals, plenty of sleep, fresh air, exercise, and daily stretching exercises
• Think of something pleasant to distract your thoughts and take them away from the headache – for example, go for a walk and look at the world around you