Medication-Overuse Headache — SCE Neurology MCQ

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ModerateHeadache & Facial PainMedication-Overuse HeadacheSCE Neurology

A 50-year-old woman presents with daily headaches. She has a history of episodic migraine but now takes codeine-paracetamol combination on most days. Her headaches have become constant, bilateral, and pressing. What is the most important management step?

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Correct answer: E — Withdraw the overused analgesic

This presentation is consistent with medication-overuse headache (MOH). The most important step is withdrawal of the overused analgesic. NICE CG150 recommends abrupt withdrawal of the overused medication. Prophylactic treatment can be started concurrently but will not be effective until the overused medication is withdrawn. A: Prophylaxis alone without withdrawal is unlikely to succeed. B: Increasing the overused medication worsens the problem. D: Triptans can also cause MOH if used on ≥10 days/month. E: LP is not indicated given the clear clinical picture.

Reference: NICE CG150 Headaches (2012, updated 2021)