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.

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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