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Medication-overuse headache: where are we now?

Katsarava, Zazaa; Jensen, Rigmorb

Current Opinion in Neurology: June 2007 - Volume 20 - Issue 3 - p 326–330
doi: 10.1097/WCO.0b013e328136c21c

Purpose of review Many important studies on medication-overuse headache have been published in the last year. Some of them investigated the pathophysiology of headache chronicity, others focused on evaluation of risk factors. The International Headache Society revised the classification criteria. We provide a summary of the new findings and concepts.

Recent findings Medication-overuse headache was previously defined by the International Headache Society as a chronic headache which occurs following overuse of headache drugs and improves after withdrawal. Hence, the improvement of headache after withdrawal was mandatory for diagnosis. The new appendix criteria appeared last year and established a broader concept of medication-overuse headache no longer requiring improvement after discontinuation of medication overuse. Several large population-based longitudinal studies clearly demonstrated that overuse of any kind of acute headache medication is the main risk factor leading to development of chronic headache. Imaging studies provided new important insights into the pathophysiology of headache chronicity. New treatment strategies have been suggested.

Summary Recent data provide better insight into pathophysiology of medication-overuse headache. Epidemiological studies clearly demonstrate the necessity of establishing a predictive model for early recognition of patients at high risk to intervene early and avoid development of chronic headache.

aDepartment of Neurology, University of Essen, Essen

bDanish Headache Center, Department of Neurology, University of Copenhagen, Glostrup Hospital, Glostrup, Denmark

Correspondence to Zaza Katsarava, MD, PhD, MSc, Consultant Neurologist, Department of Neurology, University of Essen, Hufelandstrasse 55, 45122 Essen, Denmark Tel: +49 201 723 2467; fax: +49 201 723 5919; e-mail:

© 2007 Lippincott Williams & Wilkins, Inc.