Migraine:

What is migraine?

Migraine is a genetic neurological disease characterized by episodes of multiple, often debilitating symptoms. 

How is a migraine different from a headache?

A migraine attack has multiple symptoms including a combination of headache, nausea, vomiting, increased sensitivity to light, increased sensitivity to sound, and worsening of symptoms with routine physical activities. Headache alone isn’t sufficient for a diagnosis of migraine and a migraine attack can even occur with no headache.

How is migraine diagnosed?

There are no diagnostic tests to confirm a diagnosis of migraine. Migraine is diagnosed by reviewing the patient’s medical history as well as their family’s medical history, reviewing their symptoms, conducting a complete neurological exam, and ruling out other causes for their symptoms.

Is there a cure for migraine?

At this time, there is no cure for migraine. There are, however, many treatment options that can be utilized to manage the disease.

Chronic Migraine:

What is chronic migraine?

Chronic migraine is headache on 15 or more days a month, at least eight of which must be migraine, for more than three months. 

How is chronic migraine treated?

At this point, there are no acute, preventive, or rescue medications that have been developed specifically for the treatment of chronic migraine. A treatment regimen typically includes a combination of preventive therapy to reduce the frequency and severity of attacks and acute therapy to abort attacks once they have begun. Medication and non-medication therapies should be considered.

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?

Medication overuse headache is “headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more, or 15 or more days per month, depending on the medication) for more than 3 months.” 1

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

  1. 2 Medication-overuse headache (MOH
  2. 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.
  3. 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.
  4. 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.
    1. 2.3.1 Paracetamol (acetaminophen)-overuse headache
    2. 2.3.2 Acetysalicylic acid (aspirin)-overuse headache<
    3. 2.3.3 Other non-steroidal anti-inflammatory drug (NSAID)-overuse headache
  5. 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.
  6. 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.
  7. 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.
  8. 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?

Your doctor may have his or her own recommendation, but the most common recommendation is to limit use of all the acute medications listed above to no more than two or three days per week.

Will alternating the types of acute medications used prevent medication overuse headache?

No. See 2.2.6 Medication-overuse headache attributed to combination of acute medications.

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)
Headache Classification Committee of the International Headache Society. “The International Classification of Headache Disorders, 3rd edition (beta version).” Cephalalgia. July 2013 vol. 33 no. 9 629-808. 10.1177/0333102413485658.