clinicians must be alert to the possibility of medication overuse headache in people whose headache developed or worsened while they were taking the following drugs for 3 months or more:
triptans, opioids, ergots or combination analgesic medications on 10 days per month or more or
paracetamol, aspirin or an NSAID, either alone or any combination, on 15 days per month or more
Management
explain to people with medication overuse headache that it is treated by withdrawing overused medication
advise people to stop taking all overused acute headache medications for at least 1 month and to stop abruptly rather than gradually
advise people that headache symptoms are likely to get worse in the short term before they improve and that there may be associated withdrawal symptoms, and provide them with close follow-up and support according to their needs
consider prophylactic treatment for the underlying primary headache disorder in addition to withdrawal of overused medication for people with medication overuse headache
inpatient withdrawal should not routinely be used for medication overuse headache
consider specialist referral and/or inpatient withdrawal of overused medication for people who are using strong opioids, or have relevant comorbidities, or in whom previous repeated attempts at withdrawal of overused medication have been unsuccessful
review the diagnosis of medication overuse headache and further management 4-8 weeks after the start of withdrawal of overused medication.
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