BASH Guideline

Triptan overuse may result in daily migraine like headache or an increase in migraine frequency, whereas overuse of other analgesics may lead to daily headache with features of both migraine and tension type headache (Limmroth et al., 2002).

Many patients continue to take their acute medications despite the apparent lack of effect, while also reporting significant rebound in headache when acute medications are not taken (Anderson, 1975; Peters & Horton, 1951; Rowsell et al., 1973; Saper, 1987; Wainscott et al., 1974).

The prevalence of comorbid psychiatric disorders, including depression and anxiety, is greatly increased in patients with MOH. In patients with medication overuse headache with pre-existing episodic tension type headache 67.7% have comorbid psychiatric disorders while in those with pre-existing migraine these were present in 53.7%. Depression and anxiety themselves also be risk factor (Atasoy et al., 2005).

Migraine is comorbid with depression and anxiety and these may be risk factors for developing MOH (Merikangas et al., 1990; Radat & Lanteri-Minet, 2010).

Dependence related behaviour is noted in 60–70% patients and relapses are common (Radat & Lanteri-Minet, 2010).