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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.
Headache is the most common presenting symptom in neurology and constitutes more than one-third of primary care consultations. Organized according to the presenting features of the headache (acute, episodic and chronic), this handbook provides diagnostic and treatment information for both common and uncommon causes of headache. Making maximum use of lists, bullet points, summary boxes and illustrations, it allows the reader fast access to essential information where it is needed most. Each topic is dealt with succinctly, using up-to-date knowledge and experience of the authors, all of whom are headache experts from leading clinical centers in the USA and Canada. Providing comprehensive and detailed coverage to satisfy the needs of the busy neurologist, residents in neurology, neurosurgery, psychiatry and other fields of internal medicine, this book will also be a valuable guide to practising clinicians who do not deal with headache on a regular basis.