What is migraine?
How is a migraine different from a headache?
How is migraine diagnosed?
Is there a cure for migraine?
What is chronic migraine?
How is chronic migraine treated?
Although it was developed for other conditions, onabotulinumtoxinA (Botox) was approved by the FDA for the treatment of chronic migraine in 2010. Although there is evidence that other treatments like topiramate are effective for treating chronic migraine, onabotulinumtoxinA is the only medication that's been approved by the FDA for treating chronic migraine. It was not found effective for treatment of episodic migraine.
Medication Overuse Headache:
What is medication overuse headache?
Which medications can cause medication overuse headache (MOH)?
Pretty much all the acute medications used when a migraine or headache occurs can cause MOH. The International Headache Society has done a very thorough job of outlining this in the International Classification of Headache Disorders, 3rd edition beta (ICHD-3 beta): 1
- 2 Medication-overuse headache (MOH
- 2.1 Ergotamine-overuse headache Overuse defined as ergotamine intake on 10 or more days/month on a regular basis for more than 3 months.
- 2.2 Triptan-overuse headache Overuse defined as triptan intake (any formulation) on 10 or more days/month on a regular basis for more than 3 months.
- 2.3 Analgesic-overuse headache Overuse defined as intake of simple analgesics on 15 or more days/month on a regular basis for more than 3 months.
- 2.3.1 Paracetamol (acetaminophen)-overuse headache
- 2.3.2 Acetysalicylic acid (aspirin)-overuse headache<
- 2.3.3 Other non-steroidal anti-inflammatory drug (NSAID)-overuse headache
- 2.4 Opioid-overuse headache Overuse defined as intake of opioid medications on 10 or more days/months on a regular basis for more than 3 months.
- 2.5 Combination analgesic-overuse headache Overuse defined as intake of simple analgesic medications on 10 or more days/month on a regular basis for more than 3 months.
- 2.6 Medication-overuse headache attributed to a combination of acute medications Intake of any combination of ergotamine, triptans, analgesics and/or opioids on 10 or more days/month on a regular basis for more than 3 months without overuse of any single class alone.
- 2.7 Headache attributed to other medication overuse Regular overuse for more than 3 months of a medication other than those described above.
How can medication overuse headache be avoided?
Will alternating the types of acute medications used prevent medication overuse headache?
What’s the best way for patients with chronic migraine to end medication overuse headache?
Good question! That’s exactly what this study is designed to answer. There are two protocols currently in use, but at this point, there isn’t evidence to support which of them is better for patients who have both chronic migraine and medication overuse headache. This study is designed to determine which of these two strategies works better for patients:
- Immediate discontinuation of the overused medication(s) and the start of new migraine preventive therapy or adjustment of current preventive therapy OR
- Start of new migraine preventive therapy or adjustment of current preventive therapy without immediate discontinuation of the overused medication(s)