EAN 2026 | Recognizing medication overuse headache and optimizing underlying headache management

Medication overuse headache is a secondary headache that comes after overuse of medication, and it is painkillers for the vast majority, simple analgesics such as paracetamol, ibuprofen, and ergots, and also triptans and combination drugs. And it’s not a problem if you take it one week. But if you take regular painkillers on a daily basis for more than 14 days a month for a three-month period, and that’s what many, many headache patients do. They go to the pharmacy and buy these and take it because they don’t know what else to do with a headache. And it’s not only migraine, you can develop medication overuse. It’s all types of headaches, also the secondary, post-traumatic headache, IIH headache. And it’s important to ask the patient how many painkillers do they take and how often. It’s mostly described in migraine, but it’s not only there. We are also seeing in cluster headache. And there’s this background, continuous headache, in between the peaks. And that’s really complicating the underlying headache disorder, whether it’s a migraine cluster headache, a post-traumatic headache, and nothing works, and you have to take more and more, and you become immune and resistant to other treatment. So it is a vicious circle that we have to break, and the pain system doesn’t like to have painkillers every day. You have to stop again, but it can be difficult. So the key message here is to identify what is your underlying, was it a migraine, was it a post-traumatic headache? And how can we come back to that so we can treat the underlying headache properly and not with painkillers and building every day? So we educate the patients. That’s very important. There’s brief intervention described from the Norwegian groups that very short intervention and education to the patients. Say, come on, does it really help you? And what to do when you taper it off? Stop it or taper it down to a minimum? And then you can see a completely different picture. We still have the migraines or the underlying headaches, but it’s not so severe, and it responds again. So a brief intervention is extremely important, education to the patient. But now we see, in old days, we stopped completely and waited two months before we could see a clear picture. But now we combine the education, the withdrawal of the medication or stopping the medication with a preventive. If it looks like a migraine, we could have migraine preventive. And if it looks like something else, then going for the underlying phenotype. And we have seen with eptinezumab, a study, a blind study, that called RESOLUTION, that if you put an antibody, CGRP antibody, to the patient, it has a better outcome than placebo. But still, education is the key and education also to prevent medication overuse for your patients. For a correct diagnosis is the key to a correct treatment.

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