BASH Guideline

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•            Daily headaches or worsening of headaches

•            Co-morbid depression and anxiety may exist

•            Increased risk with physical inactivity and smoking

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%. The risk of MOH is also increased in depression and anxiety (Hagen et al., 2012).

Migraine frequently co-occurs with depression and anxiety, and these conditions may serve as risk factors for the development of MOH (Merikangas et al., 1990; Radat & Lanteri-Minet, 2010).

Lifestyle factors such as smoking and physical inactivity are associated with an over two-fold increased risk of medication overuse headache (Hagen et al., 2012).

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