Medication-Overuse Headache Awareness Campaign
Join IHS in creating awareness of Medication-Overuse Headache. Share our videos in your social networks.
What is Medication-Overuse headache?
Almost all of us have headache sometimes, tension-type headache or migraine being the most common. Some unfortunately experience a gradually worsening headache despite an increasing use of painkillers. Understandably, this may lead to an extremely frustrating situation. On top of a worsening headache, medication and other strategies that previously helped, do not work as well any more – everything tried to relieve the headache seems to make it worse. This is the experience of patients who develop medication-overuse headache or MOH. Though not as common as migraine or tension-type headache, MOH is, the most common chronic headache type. The down-going spiral often becomes exceedingly burdensome also psychologically and adds to the general burden of a stressful every day and work-life.
This situation is difficult for patients to understand – it seems the headache has a “life of its own” even if handled in a way that has worked before and often, in a way that has been recommended by the treating physician. How previously well-functioning medication may contribute to maintenance of headache is indeed difficult to understand and requires awareness of the process and looking not just at the headache, but also at how the medication is used. Taking one step back and keeping track of how “at need” pain-killers are used is not easy. Patients are often aware of their medication not working as well as before but still feel that they have to take something. Some are worried about a high medication intake and have even tried to reduce their medication, often resulting in a worsening headache and thus suggesting the need to continue frequent intake. This behaviour has some similarity to addiction though it is not always easy to say if the increasing pain is driving the medication use or vice versa.
MOH develops in parallel with an increasing sensitivity also for other causes of headache and contributing factors. In addition general sensitivity for pain often increases in other parts of the body such as neck, shoulders and back, which may then contribute to frequent analgesics intake. This phenomenon of increased sensitivity to pain has been demonstrated in a number of studies in patients with MOH compared to other headaches without medication-overuse. The headache characteristics usually change over time as MOH develops. Headaches may be more un-relenting, continuous, and similar to tension-type headaches rather than the more attack wise, severe migrainous headache. However, MOH may also develop from episodic tension-type headache and in this case some headache days may become more migraine-like. This emphasises the difficulty in diagnosing the underlying, primary, headache.
There is a clear link between the medication overuse and the headache, demonstrated by the fact that headache usually improves if the patient is able to stop overusing acute painkillers. Unfortunately, an initial worsening of headache commonly occurs, for many providing “proof” that they should not stop analgesics intake. This rebound headache rarely extends over more than a few weeks.
Diagnosis of Medication-Overuse Headache
MOH is a dynamic disease that evolves over time, typically over years, in patients with a pre-existing headache with an episodic pattern, in most cases represented by migraine. The chain of events includes a worsening of frequency and/or severity of primary headache attacks over months/years paralleled by a progressively increased use of acute medications, until the threshold for chronicity (at least 15 headache days/month) and days of acute medication use (see table) is reached and maintained for at least 3 months.
The diagnosis of MOH therefore requires a careful history. A thorough examination is also necessary to exclude ‘red flags’, since multiple concurrent diseases may negatively affect the course of a pre-existing primary headache and prompt an increased use of acute medications. In the presence of any red flags, targeted diagnostic evaluation with blood tests, neuroimaging, and/or cerebrospinal fluid testing may be required. Another tool extremely important for diagnosing MOH is a headache diary or calendar, where the patient has to input the headache days and the days of use of acute medications. The diagnostic criteria of the International Classification of Headache Disorders (3rd edition) for MOH, which are shown here, are very simple and almost purely mathematical in their application.
The classification identifies multiple subtypes of medication overuse: simple analgesics, ergotamine, triptans, opioids or their combinations. The threshold for monthly days of use is set at 15 days/month for simple analgesics, while it is lowered to 10 days for the other classes. The diagnostic criteria do not consider the medication dosage per day, as reliable evidence is lacking in this regard.
Individuals receive a diagnosis of MOH along with the pre-existing headache diagnosis, usually migraine, less frequently tension-type headache, occasionally other headache types.
MOH diagnostic criteria have an inner limitation as they do not specifically mention the concept of temporal correlation between the increased use of acute medications and the worsening of headache frequency. While this correlation almost totally relies on patient’s recall, with the attached bias, it should always be searched by the clinician with an accurate history taking and, possibly, via health records or claims. Its presence substantiated the correcteness of the diagnosis and clearly informs the treatment approach whose first and main step is patient’s education about the offending action of overused acute medications.
Treatment of Medication-Overuse Headache
MOH is per definition an inappropriately treated headache. Therefore, treatment of MOH, can be viewed as an adjustment of the treatment towards a more efficient and optimal headache treatment.
Evidence based treatment of MOH consists of three elements: 1) Withdrawal of the overused and inefficient acute medication; 2) Adding an efficient preventive treatment strategy; and 3) Close follow-up and use of headache calendar.
This approach has shown to reduce headache days per month by fifty percentage; and about 70% of patients revert to an episodic headache form, meaning maximum 14 days per month with headache. Also, disability is decreased, and quality of life is increased. So, let’s have a more detailed look at each element in the MOH treatment strategy.
When talking about withdrawal, the most efficient way, is to be without any painkillers or acute migraine medication for two months. Another approach, though less efficient in reducing the headache burden, would be to cut down the use of acute medication to maximum two days a week.
The most important issue of the withdrawal is to prepare the patient. That means providing detailed information about the nature of MOH, the reasons for withdrawing, and about the withdrawal procedure and potential withdrawal symptoms. Many patients may experience transient worsening in headache, but can be relieved by rescue medication, e.g., sedative drugs, antiemetics, prednisone, nonsteroidal anti-inflammatory drugs and so on. Normally, the headache and withdrawal symptoms will decline over the first 2-3 weeks. If possible, patients should consider sick leave in these weeks.
Specialized care should be considered, if patients are overusing opioids, barbiturates, benzodiazepines, or in case of considerable co-morbidities, or previously failed withdrawal.
Early start of preventive headache treatment in combination with withdrawal is recommended. The preventive treatment should target the pre-existing headache. If the pre-existing headache diagnosis is too unclear, the start of preventives may be delayed to after withdrawal.
Close follow-up and use of headache calendar
In line with detailed information, close follow-up and support of patients are essential for succeeding MOH treatment. Most patients relapse into a new MOH within the first year.
Moreover, headache calendar is recommended as an important tool for prevention and monitoring treatment.
So, to sum up, patients with MOH should start withdrawal therapy, start effective preventive treatment, and be offered close follow-up to prevent relapse. Thank you very much for your attention.
Medication-Overuse Headache Campaign
The IHS Education and Communications Committees are proud to present this Medication-Overuse Headache Awareness Campaign.
The IHS Medication-Overuse Headache Awareness Campaign focuses on educating Healthcare Professionals, offering the essential information to assist them in managing patients with tension-type headache.
In this campaign IHS members present short videos in their own languages on ‘What is medication-overuse headache’, ‘How to diagnose medication-overuse headache’ and ‘How to treat medication-overuse headache’. The content behind these videos was developed to raise awareness and promote education amongst clinicians and healthcare professionals worldwide on medication-overuse headache and its treatment.
The core message was developed in collaboration with Professors Cristina Tassorelli, Gisela Terwindt, and Christofer Lundgren, Dr Louise Carlsen, and Professor Rigmor Jensen, in collaboration with the IHS Education Committee. We greatly appreciate all IHS members who have been involved, and who have worked so hard to make this project possible. Help us spread the word
Healthcare Professionals play a vital role in medication-overuse headache advocacy and awareness efforts. By raising awareness within the medical community and increasing educational opportunities across the world, IHS aims to have a real impact on the lives of people with medication-overuse headache.
Please use #MOH2023 in all your posts.
Share amongst your colleagues and in your social media channels the educational videos we prepared in different languages, available on the IHS YouTube channel. Follow us in social media and subscribe to our YouTube channel for more updates on tension-type headache and other educational activities.
Medication-Overuse Headache Awareness Campaign videos
Videos in Spanish, French, Italian, Portuguese, and Arabic can be viewed on the IHS YouTube channel.
What is medication-overuse headache?
How to diagnose medication-overuse headache
How to treat medication-overuse headache
Please share these videos in your network and remember to use #MOH2023 in all your posts and direct your followers to the IHS social media channels.
You can also download infographics from our Google Drive.
Utoaji wa dawa za kulevya kwa watoto na watoto wa watoto: Shirika la Afya la IHS linatoa msaada wa matibabu kwa watoto na watoto wa watoto katika kuimarisha utambuzi wa madawa ya kulevya. Kugawana video zetu katika mitandao yako ya kijamii. Ugonjwa wa kichwa unaosababishwa na kutumia dawa kupita kiasi ni nini? Karibu kila mtu ana maumivu ya kichwa wakati mwingine, maumivu ya kichwa ya aina ya mkazo au kipandauso ni ya kawaida zaidi. Kwa kusikitisha, baadhi ya watu hupata maumivu ya kichwa yanayozidi kuongezeka hatua kwa hatua licha ya kuongezeka kwa matumizi ya dawa za kupunguza maumivu. Kwa kueleweka, hilo laweza kusababisha hali yenye kukatisha tamaa sana. Kwa kuongezea maumivu ya kichwa, dawa na mbinu nyingine ambazo zilikuwa zimesaidia, hazifanyi kazi vizuri tena - kila kitu kilichojaribu kupunguza maumivu ya kichwa inaonekana kuwa kinafanya iwe mbaya zaidi. Hii ni uzoefu wa wagonjwa ambao huendeleza maumivu ya kichwa ya matumizi ya kupita kiasi ya dawa au MOH. Ingawa sio ya kawaida kama migraine au maumivu ya kichwa ya aina ya mvutano, MOH ni aina ya maumivu ya kichwa ya kawaida ya muda mrefu. Mzunguko wa kushuka mara nyingi huwa mzigo mkubwa pia kisaikolojia na huongeza mzigo wa jumla wa kila siku yenye mkazo na maisha ya kazi. Hali hii ni ngumu kwa wagonjwa kuelewa - inaonekana maumivu ya kichwa yana "maisha yake mwenyewe" hata ikiwa yanashughulikiwa kwa njia ambayo imefanya kazi kabla na mara nyingi, kwa njia ambayo imependekezwa na daktari anayetibu. Jinsi dawa zilizokuwa zikifanya kazi vizuri hapo awali zinaweza kuchangia kudumisha maumivu ya kichwa ni ngumu kuelewa na inahitaji ufahamu wa mchakato na kuangalia sio tu maumivu ya kichwa, lakini pia jinsi dawa inatumiwa. Si rahisi kurudi nyuma na kufuatilia jinsi dawa za kupunguza maumivu zinavyotumiwa "wakati wa uhitaji". Mara nyingi wagonjwa wanajua kwamba dawa zao hazifanyi kazi kama zilivyokuwa hapo awali, lakini bado wanahisi kwamba wanapaswa kuchukua dawa fulani. Baadhi ya watu wana wasiwasi juu ya matumizi ya dawa nyingi na hata wamejaribu kupunguza matumizi yao, mara nyingi ikisababisha maumivu ya kichwa na hivyo kuashiria haja ya kuendelea kuchukua dawa mara kwa mara. Utendaji huu una baadhi ya kufanana na ulevi ingawa si rahisi kusema kama maumivu ya kuongezeka ni kuendesha matumizi ya dawa au kinyume chake. MOH huendelea sambamba na kuongezeka kwa unyeti pia kwa sababu nyingine za maumivu ya kichwa na sababu zinazochangia. Kwa kuongezea, unyeti wa jumla kwa maumivu mara nyingi huongezeka katika sehemu zingine za mwili kama vile shingo, mabega na mgongo, ambayo inaweza kuchangia matumizi ya dawa za maumivu mara kwa mara. Uwezo wa kuongeza hisia za maumivu umeonyeshwa katika masomo kadhaa katika wagonjwa wenye MOH ikilinganishwa na maumivu mengine ya kichwa bila matumizi ya dawa. Kwa kawaida, dalili za maumivu ya kichwa hubadilika kadiri ugonjwa huo unavyoendelea. Maumivu ya kichwa yanaweza kuwa ya kudumu, ya kuendelea, na yanayofanana na maumivu ya kichwa ya aina ya mkazo badala ya maumivu ya kichwa ya migraine yenye nguvu zaidi. Hata hivyo, MOH inaweza pia kuendeleza kutoka maumivu ya kichwa ya aina ya mvutano na katika kesi hii baadhi ya siku za maumivu ya kichwa inaweza kuwa zaidi ya migraine. Hilo laonyesha jinsi ilivyo vigumu kugundua ugonjwa wa kichwa wa msingi. Kuna uhusiano wa wazi kati ya matumizi ya dawa kupita kiasi na maumivu ya kichwa, inayoonyeshwa na ukweli kwamba maumivu ya kichwa kwa kawaida hupungua ikiwa mgonjwa anaweza kuacha kutumia dawa za kupunguza maumivu ya haraka. Kwa kusikitisha, kuharibika kwa kichwa kwa mara ya kwanza hutokea kwa kawaida, kwa wengi kutoa <unk>uthibitisho<unk> kwamba hawapaswi kuacha matumizi ya dawa za kupunguza maumivu. Mara chache maumivu hayo ya kichwa huendelea kwa muda mrefu kuliko majuma machache. Ugonjwa wa kichwa wa overuse ni ugonjwa wa kawaida ambao huendelea kwa muda, kwa kawaida kwa miaka, kwa wagonjwa walio na maumivu ya kichwa ya awali na muundo wa vipindi, katika kesi nyingi inawakilishwa na migraine. Mfuatano wa matukio ni pamoja na kuongezeka kwa mzunguko na au ukali wa mashambulizi ya maumivu ya kichwa ya msingi kwa miezi au miaka, ikifuatiwa na kuongezeka kwa matumizi ya dawa za haraka, hadi kiwango cha muda mrefu (angalau siku 15 za maumivu ya kichwa kwa mwezi) na siku za matumizi ya dawa ya haraka (tazama meza) hufikia na kudumishwa kwa angalau miezi mitatu. Kwa hiyo, kugundua ugonjwa wa MOH huhitaji historia ya uangalifu. Uchunguzi wa kina pia ni muhimu ili kuondoa "nambari nyekundu", kwa kuwa magonjwa mengi yanayohusiana yanaweza kuathiri vibaya mwendo wa maumivu ya kichwa ya msingi yaliyopo hapo awali na kusababisha matumizi ya dawa za haraka. Kwa kuwapo kwa bendera yoyote nyekundu, tathmini ya utambuzi iliyoelekezwa na vipimo vya damu, neuroimaging, na / au upimaji wa umajimaji wa cerebrospinal inaweza kuhitajika. Njia nyingine muhimu ya kugundua ugonjwa wa kichwa ni kitabu cha kichwa au kalenda, ambapo mgonjwa anaingia siku za maumivu ya kichwa na siku za matumizi ya dawa za kukata. "Kifungu cha utambuzi cha ""International Classification of Headache Disorders"" (Kifungu cha 3) kinaonyesha kwamba maumivu ya kichwa ni ya kawaida na ya kawaida." Uainishaji huo hutambua aina ndogo nyingi za matumizi ya kupita kiasi ya dawa: dawa rahisi za kupunguza maumivu, ergotamine, triptans, opioids au mchanganyiko wao. Kiwango cha siku za matumizi ya kila mwezi ni siku 15 kwa analgesics rahisi, wakati ni kupunguzwa kwa siku 10 kwa makundi mengine. Vigezo vya utambuzi havizingatiwi kipimo cha dawa kwa siku, kwa kuwa ushahidi wa kuaminika haupatikani katika suala hili. Watu hupata utambuzi wa MOH pamoja na utambuzi wa maumivu ya kichwa ya awali, kwa kawaida migraine, mara chache maumivu ya kichwa ya aina ya mvutano, mara kwa mara aina nyingine za maumivu ya kichwa. "Kipimo cha utambuzi cha MOH kina kikomo cha ndani kwani haitajwi maalum dhana ya ""uhusiano wa muda"" kati ya kuongezeka kwa matumizi ya dawa za haraka na kuongezeka kwa mzunguko wa maumivu ya kichwa." Ingawa uhusiano huu unategemea karibu kabisa kumbukumbu ya mgonjwa, na upendeleo ulioambatanishwa, inapaswa daima kutafutwa na daktari na historia sahihi ya kuchukua na, labda, kupitia rekodi za afya au madai. Uwepo wake unaonyesha usahihi wa utambuzi na unaelezea wazi mbinu ya matibabu ambayo hatua ya kwanza na kuu ni elimu ya mgonjwa juu ya hatua ya makosa ya dawa za kukandamiza zilizotumiwa kupita kiasi. Matibabu ya maumivu ya kichwa ya overuse ya dawa (MOH) ni maumivu ya kichwa ya matibabu yasiyofaa. Kwa hiyo, matibabu ya MOH inaweza kuonekana kama marekebisho ya matibabu kuelekea matibabu ya maumivu ya kichwa yenye ufanisi zaidi na bora. Matibabu ya msingi ya ushahidi ya MOH inajumuisha vipengele vitatu: 1) Kuondoa dawa ya kukandamiza iliyotumiwa kupita kiasi na isiyo na ufanisi; 2) Kuongeza mkakati mzuri wa matibabu ya kuzuia; na 3) Ufuatiliaji wa karibu na matumizi ya kalenda ya maumivu ya kichwa. Utaratibu huu umeonyesha kupunguza siku za maumivu ya kichwa kwa asilimia 50 kwa mwezi, na karibu asilimia 70 ya wagonjwa wanarudi kwa aina ya maumivu ya kichwa ya vipindi, ikimaanisha siku 14 kwa mwezi na maumivu ya kichwa. Pia, ulemavu hupungua, na ubora wa maisha huongezeka. Kwa hiyo, hebu kuwa na kuangalia zaidi ya kina katika kila kipengele katika mkakati wa matibabu MOH. Kwa wale ambao wanafikiria kuacha, njia bora ni kutumia dawa za maumivu au dawa za kipandauso kwa miezi miwili. Njia nyingine, ingawa haifanyi kazi vizuri sana kupunguza maumivu ya kichwa, ni kupunguza matumizi ya dawa za kukandamiza hadi siku mbili kwa juma. Suala muhimu zaidi la kujiondoa ni kumtayarisha mgonjwa. Hii inamaanisha kutoa habari ya kina juu ya asili ya MOH, sababu za kujiondoa, na juu ya utaratibu wa kujiondoa na dalili za uwezekano wa kujiondoa. Kwa sababu ya hali ya maumivu ya kichwa, dawa za kuokoa inaweza kuondolewa kwa kutumia dawa za kuokoa, kama vile dawa za kulala, antiemetics, prednisone, na dawa za kuzuia uchochezi zisizo za steroid. Kwa kawaida, maumivu ya kichwa na dalili za kuacha dawa hupungua katika wiki 2-3 za kwanza. Ikiwa inawezekana, wagonjwa wapaswa kufikiria kuondoka kwa sababu ya ugonjwa katika majuma hayo. Matibabu ya pekee yanapaswa kuzingatiwa, ikiwa wagonjwa wanatumia opioids, barbiturates, benzodiazepines, au katika kesi ya co-morbidities kubwa, au kushindwa hapo awali kujiondoa. Kuanza mapema kwa matibabu ya kuzuia maumivu ya kichwa kwa kuchanganya na kuondolewa kunapendekezwa. Matibabu ya kuzuia yanapaswa kulenga maumivu ya kichwa yaliyokuwapo hapo awali. Ikiwa utambuzi wa maumivu ya kichwa uliopo hapo awali haujulikani vizuri, kuanza kwa kuzuia kunaweza kucheleweshwa hadi baada ya kuacha. Kufuatilia kwa karibu na matumizi ya kalenda ya maumivu ya kichwa: Kwa mujibu wa habari ya kina, ufuatiliaji wa karibu na msaada wa wagonjwa ni muhimu kwa mafanikio ya matibabu ya MOH. Wagonjwa wengi huanza tena kutumia dawa hiyo ndani ya mwaka mmoja. Isitoshe, kalenda ya maumivu ya kichwa inapendekezwa kuwa chombo muhimu cha kuzuia na kufuatilia matibabu. Kwa hivyo, kwa muhtasari, wagonjwa wenye MOH wanapaswa kuanza tiba ya kujiondoa, kuanza matibabu ya kuzuia yenye ufanisi, na kupewa ufuatiliaji wa karibu ili kuzuia kurudi nyuma. Asanteni sana kwa uangalifu wenu. "Kampuni ya ""Uchunguzi wa Ugonjwa wa Kichwa"" ya IHS inafurahi kutoa taarifa hii ya ""Uchunguzi wa Ugonjwa wa Kichwa"" kwa watumiaji wa afya." Kampeni ya Ujuzi wa maumivu ya kichwa ya overuse ya IHS inazingatia kuelimisha wataalamu wa huduma za afya, ikitoa habari muhimu ili kuwasaidia kusimamia wagonjwa wenye maumivu ya kichwa ya aina ya mvutano. Katika kampeni hii wanachama wa IHS hutoa video fupi katika lugha zao wenyewe juu ya "Ni nini maumivu ya kichwa ya matumizi ya dawa", "Jinsi ya kugundua maumivu ya kichwa ya matumizi ya dawa" na "Jinsi ya kutibu maumivu ya kichwa ya matumizi ya dawa". Video hizi zilitengenezwa ili kuongeza ufahamu na kukuza elimu kati ya madaktari na wataalamu wa huduma za afya ulimwenguni kote juu ya maumivu ya kichwa ya matumizi ya dawa na matibabu yake. Ujumbe wa msingi uliundwa kwa kushirikiana na Profesa Cristina Tassorelli, Gisela Terwende na Christofer Lundgren, Dk Louise Carlsen na Profesa Rigmor Jensen, kwa kushirikiana na Kamati ya Elimu ya IHS. Tunashukuru sana kwa wanachama wote wa IHS ambao wamejihusisha, na ambao wamefanya kazi kwa bidii sana kufanya mradi huu uwezekane. Wazo la kueneza habari kuhusu maumivu ya kichwa ni muhimu kwa wataalamu wa afya katika juhudi za kutetea na kuelimisha juu ya madawa ya kulevya. Kwa kuongeza ufahamu ndani ya jamii ya matibabu na kuongeza fursa za elimu ulimwenguni kote, IHS inakusudia kuwa na athari halisi kwa maisha ya watu wenye maumivu ya kichwa ya matumizi ya dawa. Tafadhali tumia #MohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohM Kuunganisha na kushirikiana na marafiki zako kwenye mitandao ya kijamii, unaweza kupata video za mafunzo zilizotengenezwa na kuunganishwa na wavuti ya YouTube. Tufuate kwenye mitandao ya kijamii na usajili kituo chetu cha YouTube kwa habari zaidi juu ya maumivu ya kichwa ya aina ya mvutano na shughuli zingine za elimu. Video za kampeni ya uelewa wa maumivu ya kichwa ya matumizi ya dawa ya kupita kiasi, katika Kihispania, Kifaransa, Kiitaliano, Kireno, na Kiarabu, zinaweza kutazamwa kwenye kituo cha YouTube cha IHS. Ugonjwa wa kichwa unaosababishwa na kutumia dawa kupita kiasi ni nini? Jinsi ya kugundua maumivu ya kichwa ya matumizi ya dawa ya kupita kiasi Tafadhali shiriki video hizi kwenye mtandao wako na kumbuka kutumia #MohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohMohM Unaweza pia kupakua infographics kutoka Google Drive yetu.