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Headache - assessment - Management
How do I diagnose medication overuse and other secondary causes of headache?
- Exclude symptoms of serious secondary causes of headache, before considering other secondary causes.
- Suspect medication-overuse headache (MOH) in people with tension-type headache (TTH) or migraine, when they experience a chronic headache (headache on more than 15 days a month) that develops or worsens with frequent use of any pain relief medication.
- MOH can occur with frequent use of any symptomatic treatment for acute headache. Typically, it develops with drug treatment of episodic migraine or TTH, but may occur in people with migraine or TTH who take analgesics for other painful conditions.
- The symptoms of MOH resemble chronic TTH or chronic migraine; people overusing triptans are more likely to have migraine-like symptoms.
- MOH resolves following withdrawal of symptomatic treatment. This may result in complete resolution of the headache or leave the person with their original episodic migraine or TTH.
- Suspect other secondary causes when headache is associated with:
- Caffeine withdrawal, in people consuming frequent caffeinated drinks such as tea, coffee, or colas.
- Medications known to cause headache, such as nitrates and calcium channel blockers.
- Pain that is localized to structures in the head and neck (such as the eyes, ears, sinuses, temporomandibular joint, teeth, or neck) indicative of conditions such as acute otitis media and sinusitis.
- Fever or general malaise and evidence of systemic infection.
- Head or facial pain in the area of a herpetic eruption.
- If symptoms of a secondary cause of headache have been excluded, consider a diagnosis of tension-type headache or migraine (common primary causes of headache).
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