When should I consider referring a patient with MOH to a specialist for further management?

Consider referring a patient with medication overuse headache to a specialist if there is uncertainty about the diagnosis or atypical symptoms, such as motor weakness, double vision, visual symptoms affecting only one eye, poor balance, or decreased level of consciousness ¹.

Refer if previous repeated drug withdrawal attempts have been unsuccessful ¹.

Refer if the patient is overusing strong opioids, barbiturates, or tranquilizers, or has significant comorbidities needing specialist management ¹.

Refer if there is suspicion of serious underlying causes, such as red flags or a serious secondary headache, or if there are red flags or a suspected serious underlying cause of headache ¹.