Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Effectively counseling patients on medication overuse and reducing analgesic intake involves clear communication about the diagnosis, risks, and management plan.
- Explain the diagnosis: Inform patients that medication overuse headache (MOH) can worsen their existing headache disorder, such as migraine or tension-type headache, and that overuse of acute headache medications is the cause NICE CKS.
- Discuss risks: Emphasize that frequent use of analgesics or specific drugs like triptans, ergotamines, and opioids can lead to chronic headache and medication overuse headache NICE CKS,NICE CG150.
- Advise on withdrawal: Counsel patients to stop all overused acute headache medications abruptly for at least one month, as early withdrawal is the main treatment NICE CKS,NICE CG150.
- Prepare for withdrawal symptoms: Warn that headaches may initially worsen and withdrawal symptoms such as nausea, sleep disturbance, anxiety, and restlessness may occur for 1–2 weeks, but improvement usually follows within weeks to months NICE CKS.
- Use a headache diary: Encourage patients to keep a headache diary to track headache frequency, severity, and medication use during withdrawal to monitor progress NICE CKS.
- Provide ongoing support: Arrange regular follow-up to review symptoms, provide encouragement, and reassess the underlying headache disorder 4–8 weeks after withdrawal starts NICE CKS,NICE CG150.
- Prevent relapse: Advise limiting future use of acute headache medication to no more than 2 days per week to reduce the risk of recurrence NICE CKS.
- Offer information and support resources: Provide patient leaflets and direct patients to support organizations such as Lifting the Burden, The Migraine Trust, and the British Association for the Study of Headache NICE CKS.
- Address comorbidities: Assess and manage associated conditions like anxiety, depression, and chronic pain, which may contribute to medication overuse NICE CKS.