Drug overuse and rebound headache.
The overuse of acute medications in patients who are headache-prone poses a great challenge to headache management. Medication overuse-induced headache represents one of the most common iatrogenic disorders. It is the reason that most patients visit headache subspecialty clinics worldwide and often is the cause of an intractable or worsening headache in primary headache sufferers. The recent development of acute headache medications, especially the triptans, has provided increased migraine relief; however, the incidence of triptan-overuse headache has also increased. Awareness of medication overuse-induced headache and familiarity with the diagnosis and the treatment of this disorder are important to physicians who treat patients with headache. Comment: Medication overuse headache is the bugaboo of most neurologists and headache specialists, and this review is by a master of that topic who provides clinical guidance for the condition's recognition and treatment. SJT I would agree with Dr. Tepper. We need to scrutinize closely this group of patients to avoid replacing the "ergot abusers" of the past with the triptan overusers. Diener et al has proposed that patients should restrict triptan use to <12 attacks per month. DSM (Headache 2003 Apr;43(4):427)(Silberstein SD, Liu D.)