Advertisement

Journal of Neurology

, Volume 266, Issue 12, pp 3167–3170 | Cite as

Eighty years of Medication-Overuse Headache: what about Medication-Overuse Backpain?

  • Benjamin LuchtingEmail author
  • Jens Heyn
Short Commentary

Abstract

Introduction

Although chronic low back pain (CLBP) is one of the most common pain syndromes, up to now, clear pathophysiological causes or specific treatment options are missing. Medication-overuse has been associated with chronic headache, but never with CLBP.

Hypothesis

Based on several similarities between CLBP and Medication-Overuse Headache (MOH), we hypothesized that medication-overuse might contribute to CLBP as well, maybe even as an own entity. Might there be something like Medication-Overuse Backpain (MOB)?

Methods

We substantiate our hypothesis with a preliminary case-series analyzing five patients suffering from CLBP with a marked medication-overuse. In these patients, a stepwise analgesic withdrawal was recommended.

Results

Within 6 months of recruitment, five patients fulfilled the inclusion criteria and successfully completed discontinuation of their medication. All patients reported noticeable pain relief, despite the discontinuation of their analgesics. Withdrawal was well tolerated in all cases.

Conclusions

Considering our results, the described withdrawal method seems to be a simple and safe method to achieve pain reduction while simultaneously preventing organ damage. Despite the preliminary character of our results, our hypothesis might stimulate a new understanding of CLBP’s pathophysiology.

Keywords

Pain Headache Medication-Overuse Headache Back pain 

Notes

Author contributions

All authors contributed to the case-series conception and design. Hypothesis and data collection were performed by BL. Conceptualization, data analysis, writing, review, and editing were performed by BL and JH. The first draft of the manuscript was written by BL, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical standards

The manuscript does not contain a clinical study.

References

  1. 1.
    Boes CJ, Capobianco DJ (2005) Chronic migraine and medication-overuse headache through the ages. Cephalalgia 25(5):378–390CrossRefGoogle Scholar
  2. 3.
    Diener HC, Holle D, Solbach K, Gaul C (2016) Medication-overuse headache: risk factors, pathophysiology and management. Nat Rev Neurol 12(10):575–583CrossRefGoogle Scholar
  3. 2.
    Scher AI, Rizzoli PB, Loder EW (2017) Medication overuse headache: an entrenched idea in need of scrutiny. Neurology 89(12):1296–1304CrossRefGoogle Scholar
  4. 4.
    de Goffau MJ, Klaver ARE, Willemsen MG et al (2017) The effectiveness of treatments for patients with medication overuse headache: a systematic review and meta-analysis. J Pain 18(6):615–627CrossRefGoogle Scholar
  5. 5.
    Balague F, Mannion AF, Pellise F, Cedraschi C (2012) Non-specific low back pain. Lancet 379(9814):482–491CrossRefGoogle Scholar
  6. 6.
    Becker A, Held H, Redaelli M et al (2010) Low back pain in primary care: costs of care and prediction of future health care utilization. Spine (Phila Pa 1976) 35(18):1714–1720CrossRefGoogle Scholar
  7. 7.
    Luchting B, Rachinger-Adam B, Zeitler J, Egenberger L, Möhnle P, Kreth S, Azad SC (2014) Disrupted TH17/Treg balance in patients with chronic low back pain. PLoS ONE 9(8):e104883CrossRefGoogle Scholar
  8. 8.
    Airaksinen O, Brox JI, Cedraschi C, et al. (2006) Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 15 Suppl 2:S192–S300.CrossRefGoogle Scholar
  9. 9.
    Straube A, Pfaffenrath V, Ladwig KH et al (2010) Prevalence of chronic migraine and medication overuse headache in Germany–the German DMKG headache study. Cephalalgia 30(2):207–213CrossRefGoogle Scholar
  10. 10.
    Schramm SH, Moebus S, Lehmann N et al (2015) The association between stress and headache: a longitudinal population-based study. Cephalalgia 35(10):853–863CrossRefGoogle Scholar
  11. 11.
    Westergaard ML, Munksgaard SB, Bendtsen L, Jensen RH (2016) Medication-overuse headache: a perspective review. Ther Adv Drug Saf 7(4):147–158CrossRefGoogle Scholar
  12. 12.
    Koushede V, Hansen EH, Andersen A, Holstein BE (2012) Young adults' medicine use for headache: the combined effect of socioeconomic position and perceived stress, and the contribution of sense of coherence. Res Social Adm Pharm 8(6):533–541CrossRefGoogle Scholar
  13. 13.
    Tetsunaga T, Tetsunaga T, Nishida K et al (2018) Drug dependence in patients with chronic pain: a retrospective study. Medicine (Baltimore) 97(40):e12748CrossRefGoogle Scholar
  14. 14.
    Vereckei E, Susanszky E, Kopp M et al (2013) Psychosocial, educational, and somatic factors in chronic nonspecific low back pain. Rheumatol Int 33(3):587–592CrossRefGoogle Scholar
  15. 15.
    Vandenbussche N, Laterza D, Lisicki M et al (2018) Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain 19(1):50CrossRefGoogle Scholar
  16. 16.
    Evers S, Jensen R, European Federation of Neurological S. Treatment of medication overuse headache--guideline of the EFNS headache panel. Eur J Neurol 2011;18(9):1115–1121.Google Scholar
  17. 17.
    Evers S, Marziniak M (2010) Clinical features, pathophysiology, and treatment of medication-overuse headache. Lancet Neurol 9(4):391–401CrossRefGoogle Scholar
  18. 18.
    Cargnin S, Viana M, Sances G, Tassorelli C, Terrazzino S (2018) A systematic review and critical appraisal of gene polymorphism association studies in medication-overuse headache. Cephalalgia 38(7):1361–1373CrossRefGoogle Scholar
  19. 19.
    Cevoli S, Mochi M, Scapoli C, Marzocchi N, Pierangeli G, Pini LA, Cortelli P, Montagna P (2006) A genetic association study of dopamine metabolism-related genes and chronic headache with drug abuse. Eur J Neurol 13(9):1009–1013CrossRefGoogle Scholar
  20. 20.
    Belanger S, Ma W, Chabot JG, Quirion R (2002) Expression of calcitonin gene-related peptide, substance P and protein kinase C in cultured dorsal root ganglion neurons following chronic exposure to mu, delta and kappa opiates. Neuroscience 115(2):441–453CrossRefGoogle Scholar
  21. 21.
    Lai TH1, Wang SJ. Neuroimaging Findings in Patients with Medication Overuse Headache. Curr Pain Headache Rep 2018;22(1):1.Google Scholar
  22. 22.
    Schwedt TJ, Chong CD (2017) Medication Overuse Headache: Pathophysiological Insights from Structural and Functional Brain MRI Research. Headache 57(7):1173–1178CrossRefGoogle Scholar
  23. 23.
    Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, Toom K, Vandervorst F, Quintana S, Paemeleire K, Katsarava Z (2018) Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain 19(1):50CrossRefGoogle Scholar
  24. 24.
    Riederer F, Marti M, Luechinger R, Lanzenberger R, von Meyenburg J, Gantenbein AR, Pirrotta R, Gaul C, Kollias S, Sándor PS (2012) Grey matter changes associated with medication-overuse headache: correlations with disease related disability and anxiety. World J Biol Psychiatry 13(7):517–525CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Interdisciplinary Pain CenterKlinikum Landsberg Am LechLandsberg am LechGermany
  2. 2.Department of Anesthesiology and Pain MedicineLudwig-Maximilians-University Munich (LMU)MunichGermany

Personalised recommendations