Transcript David Watson Medication Overuse Headache presentation

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Dr David PB Watson
Aberdeen
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Background Information
Case Presentation
General Discussion with Qs and As
8.2 [G44.41 or G44.83] Medication-overuse
headache†
 A. Headache present on ≥15 days/month
fulfilling criteria C and D
 B. Regular overuse for >3 months of one or more
drugs that can be taken for acute and/or
symptomatic treatment of headache
 C. Headache has developed or markedly
worsened during medication overuse
 D. Headache resolves or reverts to its previous
pattern within 2 months after discontinuation of
overused medication
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Simple Analgesics 15
days a month
 Opiate e.g. codeine 10
days a month
 Triptans 10 days a
month
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Paracetamol 450 mg
Codeine 10 mg
Doxylamine
Caffeine
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Codeine
Ibuprofen
Caffeine (headache)
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Codeine 12.8 mg
Ibuprofen 200mg
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Codeine 8 mg
Paracetamol 500 mg
Buclizine (Pink)
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Migraine
Tension Headache
Cluster (only if migraine tendency)
Hemicrania Continua
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If taking pain killers for other pain and have
migraine can get medication overuse
headache
If no headache tendency taking pain killers
won’t cause headache
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Typical scenarios are
 More frequent headache e.g. in perimenopausal
period, work stress, insomnia leading to increased
painkiller use
 New pain condition or worsening pain condition in
patient with migraine requiring increased
medication
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Normal acute and preventer treatments tend
to be ineffective
Management relies on withdrawal of
overused medication for 8 weeks. “Stopping
the Juice!”
Withdrawal should be gradual for opiates and
can be abrupt for other medications
Headache can get worse before it gets better
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42 year old executive with migraine
Business trip 4 months ago and came back
with severe migraine and now getting
headache every day
Using a triptan every second day, migraleve
most days and paracetamol every day
Stopped all medication except paracetamol
with no headache relief
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39 year old lady with migraine and severe
back pain
Using tramadol every day for back pain and
triptan and ibuprofen most days for headache
Stopped ibuprofen and triptan and headache
a lot better
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Stop all the Juice
Treat the worst pain
In patients with complex pain conditions
modifying treatment regimes can give
benefit