Medication-Overuse Headache: Risk Factors May Serve as Treatment Progress Indicators

older man holding head in his hands
older man holding head in his hands
Factors that were associated with medication overuse headache in this study included high headache-related disability, attempts to escape and avoid stimuli associated with pain, and the use of combination medications.

Factors associated with medication-overuse headaches included greater headache-related disability, fear of pain, and use of combination headache medication, according to a recent study published in Headache.

Demographics, headache variables, psychiatric variables, medication use, and substance use information were obtained from patients seeking treatment for headache. These headaches were categorized as medication-overuse headaches or not medication-overuse headaches. Associated risk factors for medication-overuse headache were then compared between groups. 

Among the 164 study participants, 43 met the diagnostic criteria for medication-overuse headache. Participants with medication-overuse headache reported greater headache-related disability, escape and avoidance responses indicative of fear of pain, and use of combination medications for headache relative to non-medication-overuse headache controls.

The study authors wrote, “The present findings support the Choosing Wisely recommendation that opioids and opioid-combination analgesics should only be used for headache as a last resort, underscoring the role of triptans for individuals who respond poorly to nonsteroidal anti-inflammatory drugs and daily preventive medications for headache patients at risk for [medication-overuse headache].”

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They also noted a possible application of the risk factors in tracking treatment progress, suggesting, “These variables may be used in conjunction to identify [people with] headache who are unable or reluctant to disclose medication overuse and who would benefit from further interventions.”


Peck KR, Roland MM, Smitherman TA. Factors associated with medication-overuse headache in patients seeking treatment for primary headache [published March 9, 2018]. Headache. doi: 10.1111/head.13294