• Amaal J Starling, Charlene Hoffman-Snyder, Rashmi B Halker, Kay E Wellik, Bert B Vargas, David W Dodick, Bart M Demaerschalk, and Dean M Wingerchuk.
• Department of Neurology and Library Services, Mayo Clinic, Scottsdale, AZ 85255, USA.
• Neurologist. 2011 Sep 1; 17 (5): 297-9.

BackgroundThe development of medication overuse headache (MOH) is associated with frequent use of analgesics, especially opiates, for treatment of primary headache disorders, particularly migraine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat migraine.ObjectiveTo critically evaluate evidence estimating the risk of MOH associated with NSAID therapy in patients with migraine.MethodsThe objective was addressed through the development of a structured, critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and headache neurology content experts.ResultsThe 1-year incidence of MOH was 2.5%. In patients with low (0 to 4 d monthly) to moderate (5 to 9 d monthly) baseline headache frequency, NSAIDs were not associated with progression to MOH and may be protective (odds ratio=0.31; 95% confidence interval, 0.27-0.34). However, in patients with a high baseline headache frequency (10 to 14 d monthly), NSAIDs are associated with progression to MOH (odds ratio=1.93; 95% confidence interval, 1.82-2.06).ConclusionsAcute NSAID therapy is associated with progression to MOH in migraineurs with a high baseline migraine frequency but may be protective in patients with low baseline headache frequency. However, a causal role for NSAIDs in progression from episodic to chronic headache has not been established.

15 keywords...

hide…