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Medication Overuse Headache: Causes, Consequences, and Treatment

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Drug Abuse and Addiction in Medical Illness

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Abstract

All primary headache subtypes (migraine, tension-type headache, cluster headache) may become complicated by medication overuse headache (MOH). MOH has developed into the third most common type of headache after tension-type headache and migraine. The prevalence reaches approximately 1% of the world’s population and shows an increasing trend. MOH is a condition in which headaches become increasingly frequent as a patient begins to use more and more acute headache medications. The initial headache frequency is one of the factors that may play a role in the development of MOH. However, the reasons why some patients overuse acute treatments of headaches whereas others do not are not clearly understood. MOH might be prompted and sustained by some psychological states and behavioral disorders, including fear of headache, anticipatory anxiety of attacks, and psychological drug dependence. A range of behaviors presumed to be related to excessive medications are being increasingly recognized in MOH disease. These behaviors are linked by their reward-based and repetitive natures. Whether these behaviors are simply related to medications interacting with an underlying individual vulnerability or whether the primary pathological features of MOH play a role is not known. Neurobiological mechanisms underlying drug dependence and reward system (i.e. endocannabinoids, dopamine, orexins) might also be involved in MOH. The study of these neurobiological mechanisms and behaviors might allow not only a greater insight into the pathophysiology of MOH but also an improved clinical management of this disorder. Although many questions remain unanswered, it is encouraging that several clinical and experimental advances have shed new light on the neuropharmacology of nociception and have prompted new hope for more effective treatments of such diverse problems as chronic headache pain, migraine, and drug dependency.

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Authors and Affiliations

  1. Centro Cefalee, Clinica Neurologica, Dipartimento Cranio Spinale, U.O.C. Neurologia, Ospedale S. Eugenio, P.le dell’Umanesimo 10, 00144, Roma, Italy

    Letizia M. Cupini

  2. Clinica Neurologica, Università degli Studi di Perugia, Perugia, Italy

    Paola Sarchielli & Paolo Calabresi

Authors
  1. Letizia M. Cupini
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  2. Paola Sarchielli
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  3. Paolo Calabresi
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Correspondence to Letizia M. Cupini .

Editor information

Editors and Affiliations

  1. Inst. Pharmaceutical Sciences, Department of Psychopharmacology, Utrecht University, Universiteitsweg 99, Utrecht, 3584CG, Netherlands

    Joris C. Verster

  2. Dept. Psychiatry, Medical University of South Carolina, President St. 67, Charleston, 29425, South Carolina, USA

    Kathleen Brady

  3. School of Medicine, Div. Alcoholism & Drug Abuse, New York University, First Ave. 550, New York, 10016, New York, USA

    Marc Galanter

  4. Institute of Psychiatry, King's College London, National Addiction Centre, Windsor Walk 4, London, SE5 8AF, United Kingdom

    Patricia Conrod

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Cupini, L.M., Sarchielli, P., Calabresi, P. (2012). Medication Overuse Headache: Causes, Consequences, and Treatment. In: Verster, J., Brady, K., Galanter, M., Conrod, P. (eds) Drug Abuse and Addiction in Medical Illness. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3375-0_28

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