Synopsis
Identify headache made more frequent by regular acute-medicine exposure, explain the diagnosis without blame, and support withdrawal while treating the underlying primary headache disorder.
- Suspect medication-overuse headache when headache is present on at least 15 days per month and one or more acute headache medicines have been overused for more than 3 months.
- Triptans, opioids, ergots and combination analgesics reach the overuse threshold at 10 or more days monthly; paracetamol, aspirin and NSAIDs reach it at 15 or more days.
- Count treatment days rather than tablet numbers, and include over-the-counter cold, pain and caffeine combinations that the patient may not regard as headache medicines.
Key red flags
Escalating strong opioid use, withdrawal between doses, multiple sedatives, severe mental illness or previous failed detoxification signals need for specialist support and sometimes inpatient care.
Investigation priorities
Count total headache days, migraine-feature days and exposure days for every acute medicine class.
Management branches
Headache has become frequent, chronic or progressively less responsive to rescue treatment.
- Ask for total monthly headache days and reconstruct every acute treatment day using prescriptions, purchased products and medicines taken for other pain.
- Apply the correct 10-day or 15-day class threshold over more than 3 months, considering cumulative exposure to several classes.