Diagnostic criteria: Medication-overuse headache (ICHD-3 beta 2013). A Headache occurring on at least 15 days/month in a patient with a pre-existing headache disorder. B Regular overuse for more than 3 months of one or more substances used for acute or symptomatic treatment of headache. C Not better explained by another ICHD-3 diagnosis.
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin and mucous membranes Eyes [photophobia (photophobia)] Neck [meningismus?/painfulness and increased resistance to movements of the head in the cervical spine; due todifferential diagnosis: meningitis (meningitis), unspecified] Extremities [paralysis … Drug-Induced Headache: Examination
Usually, laboratory diagnostics are not required. 2nd-order laboratory parameters-depending on the results of the history, physical examination, and obligatory laboratory parameters-for differential diagnostic workup Small blood count Inflammatory parameters – CRP (C-reactive protein). Fasting glucose (fasting blood sugar) CSF puncture (collection of cerebrospinal fluid by puncture of the spinal canal) for CSF diagnosis.
Therapeutic target Relief of withdrawal symptoms. Therapy recommendations If educating the patient alone does not lead to cessation of medication overuse, medication interruption or withdrawal treatment is required. Medication interruption or withdrawal (sometimes only for 2 to 4 weeks) can break a medication overuse headache in most patients.The term medication interruption refers to the fact … Drug-Induced Headache: Drug Therapy
The diagnosis of drug-induced headache (medication-induced headache) is made clinically. Optional medical device diagnostics-depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics-are used for differential diagnosis Magnetic resonance imaging of the skull (cranial MRI, cranial MRI, or cMRI) – indicated for new-onset chronic headache of advanced age or … Drug-Induced Headache: Diagnostic Tests
To prevent drug-induced headache (medication-induced headache), attention must be paid to reducing individual risk factors. Behavioral risk factors Drug use Heroin Overweight (BMI ≥ 25, obesity). Medication Acetylcholinesterase inhibitors (donezepil, galantamine, rivastigmine). Alpha-adrenoreceptor antagonists or alpha-blockers (alfuzosin, tamsulosin). Analgesics [analgesic-induced MOH is preceded by an average duration of use of 4.8 years] Non-opioid analgesics (flupirtine). … Drug-Induced Headache: Prevention
The following symptoms and complaints may indicate drug-induced headache (drug-induced headache): Diffuse dull aching headache that affects the entire head – often occurs in headache patients with analgesic overuse Frequency increase of migraine and later pulsating headache, possibly nausea (nausea) – common in migraine patients with triptan overuse Drug-induced headache occurs most commonly with triptans … Drug-Induced Headache: Symptoms, Complaints, Signs
Eyes and ocular appendages (H00-H59). Ocular migraine (synonyms: Ophthalmic migraine; Migraine ophtalmique) – variant of migraine in which there are transient, bilateral visual disturbances (flickering, flashes of light, scotomas (restrictions of the visual field); similar to “normal” migraine with aura); often without headache, but sometimes with headache, which sometimes occurs only after the visual disturbances; … Drug-Induced Headache: Or something else? Differential Diagnosis
The following are the major disorders or complications that may be contributed to by drug-induced headache (drug-induced headache): Psyche – Nervous system (F00-F99; G00-G99). Chronic headache
Medical history (history) is an important component in the diagnosis of drug-induced headache (medication-induced headache). Family history Social history What is your occupation? Are you exposed to harmful working substances in your profession? Is there any evidence of psychosocial stress or strain due to your family situation? Current medical history/systemic history (somatic and psychological complaints). … Drug-Induced Headache: Medical History
Pathogenesis (disease development) In principle, any drug used to treat headache can also induce headache. Neurobiological processes of pain processing and psychological factors seem to play a role. A genetic predisposition seems to be a prerequisite for the development of drug-induced headache. The identified genes are involved in different processes such as development of dependence, … Drug-Induced Headache: Causes
