Abstract
Medication overuse headache (MOH) is a problem that is estimated to occur in up to 1% of the population. It is a common feature underlying chronic headache, especially chronic migraine. MOH represents a major diagnostic and therapeutic challenge. Many patients are referred to headache specialty clinics, where they can represent the majority of patients. The syndrome remains underdiagnosed and the role of symptomatic medication overuse in producing MOH is often underestimated. With proper education of medical providers, prevention of this too often intractable syndrome could be improved. The basis of therapy is discontinuance of the abused medication. Additional treatment relies on a multifaceted approach that embraces proper use of symptomatic pain medications and management of psychiatric comorbidities and also emphasizes patient education. Various pharmacological regimens, both abortive and prophylactic, are available. Further scientific study is warranted to elucidate the ultimate mechanisms of this syndrome and define more effective treatments. This article gives detailed clinical description, tentative pathophysiological explanation, and therapeutic suggestions. Drug Dev Res 68:449β460, 2007. Β© 2008 WileyβLiss, Inc.