ABSTRACT
This study aims to highlight the overuse of analgesics in patients with chronic daily headache who meet criteria for probable medication overuse headache. This was a cross-sectional comparative study conducted at the department of Neurology, JPMC, Karachi during a period of 1 year i.e. from 01-01-2011 to 31-12-2011. All patients with chronic daily headache were screened for probable Medication Overuse Headache. Total of 110 patients who met ICHD-II [international classification of headache disorder] criteria for probable Medication Overuse Headache [MOH] were included in this study. Detailed history and neurological examination were performed in all cases with appropriate blood workup, CSF studies and MRI+MRV in those cases where required. Drug history was taken in detail in all cases and pattern of overuse of different acute symptomatic medications was assessed with reference to underlying primary headache disorder. Total of 110 patients who met ICHD-II [revised] Criteria for probable MOH were included in this study. Females outnumbered males i.e. 2.3:1. This gender preference was noted in all primary headache subtype. Migraine was found more frequently[44.2%] in younger age groups with probable MOH while TTH [tension type headache] [55%] and other primary [83%] headache disorder [including Cluster Headache, New daily persistent headache] were more frequent disorders in old age patients with probable MOH. Among different analgesic medications, simple analgesics were found to be the most frequently overused acute symptomatic medication [66%] followed by combination analgesics [40.9%] and triptans /ergots [14.6%]. Use of combinations of various acute symptomatic medications was also assessed in patients with chronic primary headaches who met the criteria for probable MOH. Excessive use of acute symptomatic drugs without consultation with the treating physician should be discouraged. Patient education is very important about the genesis of the problem. Prophylactic treatment and follow up visits should be encouraged