Published online by Cambridge University Press: 09 October 2017
Medication overuse headache (MOH) is defined as headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute or symptomatic headache medication (on 10 or more, or 15 or more days per month, depending on the medication) for more than three months. Triptans, NSAIDs, acetaminophen, ergotamine, barbiturates, and opioids can all cause MOH. Although the optimal treatment strategy for MOH is debated, treatments include discontinuing the overused medications and treating with preventive migraine medications. In the ED, it is important to recognize patients who have MOH to provide appropriate treatment recommendations for MOH and to avoid perpetuating the patient’s medication overuse. In general, ED treatment of the patient with frequent headaches should not include narcotics or butalbital-containing medications as they are associated with the highest risk of developing MOH as well as the potential to create drug-seeking behavior. Proper follow-up should be arranged prior to discharge from the ED.