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Risk Factors for and Management of Medication-Overuse Headache

Lipton, Richard B. MD, FAAN

CONTINUUM: Lifelong Learning in Neurology: August 2015 - Volume 21 - Issue 4, Headache - p 1118–1131
doi: 10.1212/CON.0000000000000216
Review Articles

ABSTRACT Purpose of the Review: This review focuses on patients with migraine who frequently use acute medications.

Recent Findings: Chronic migraine and medication-overuse headache are common in the general population and often coexist. According to new diagnostic criteria, both diagnoses can be made for an individual patient. Evidence is slowly emerging on the most appropriate management approach for both disorders.

Summary: Although the relationship of the primary headache disorder and the pattern of overuse varies, medication-overuse headache is a secondary disorder attributable to the overuse of acute medications. While distinguishing chronic migraine and medication-overuse headache may not always be possible, treatment approaches are similar for the two disorders.

Address correspondence to Dr Richard B. Lipton, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Room 332, Rousso Building, Department of Neurology, Bronx, NY 10461,

Relationship Disclosure: Dr Lipton serves as a consultant for and receives personal compensation for speaking engagements and paid travel accommodations/meeting expenses from Alder Biopharmaceuticals Inc; Allergan, Inc; Autonomic Technologies, Inc; Avanir Pharmaceuticals, Inc; Boston Scientific Corporation; Bristol-Myers-Squibb Company; CoLucid Pharmaceuticals, Inc; Dr. Reddy’s Laboratories; electroCore Medical, LLC; eNeura Inc; Labrys Biologics; Merck & Co, Inc; Novartis AG; Teva Pharmaceutical Industries Ltd; and Vedanta Biosciences. Dr Lipton receives personal compensation for speaking engagements and paid travel accommodations/meeting expenses from the American Headache Society. Dr Lipton receives honoraria from Informa PLC and owns stock or stock options in eNeura Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Lipton discusses the unlabeled/investigational use of acebutolol, candesartin, captopril, divalproex sodium, lisinopril, metoprolol, nadolol, Petasites hybridus, propranolol, timolol, and topiramate for the treatment of chronic migraine and the use of naproxen, naratriptan, and prednisone for the acute treatment of migraine.

© 2015 American Academy of Neurology
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