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Pathophysiology of medication overuse Table of Contents February 2012, 32 (3)
headache: Insights and hypotheses from This Article
preclinical studies Published online before print
March 28, 2011, doi:
10.1177/0333102411402367
Ian D Meng1, Cephalalgia May 2011 v ol. 31 no. 7
851-860
David Dodick2,
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Michael H Ossipov3 and Full Text
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Frank Porreca1,3⇓ Full Text (PDF)
of Cephalalgia
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Author Affiliations Version of Record - May 20, 2011
0333102411402367v 1 - Mar 28, 2011
Frank Porreca, Department of Pharmacology, University of Arizona, Tucson, AZ Submit a Manuscript
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85724, USA Email: frankp@u.arizona.edu
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Introduction: Medication overuse headache (MOH) is a clinical concern in the
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management of migraine headache. MOH arises from the frequent use of medications Similar articles in this journal
used for the treatment of a primary headache. Medications that can cause MOH Similar articles in PubMed
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include opioid analgesics as well as formulations designed for the treatment of Dow nload to citation manager
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migraine, such as triptans, ergot alkaloids, or drug combinations that include caffeine Request Reprints
and barbiturates.
- Citing Articles
Literature review: Gathering evidence indicates that migraine patients are more
Citing articles via Google Scholar International Headache Society
susceptible to development of MOH, and that prolonged use of these medications
increases the prognosis for development of chronic migraine, leading to the suggestion - Google Scholar
that similar underlying mechanisms may drive both migraine headache and MOH. In Articles by Meng, I. D.
this review, we examine the link between several mechanisms that have been linked to Articles by Porreca, F.
migraine headache and a potential role in MOH. For example, cortical spreading Search for related content

depression (CSD), associated with migraine development, is increased in frequency - PubMed

with prolonged use of topiramate or paracetamol.
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Conclusions: Increased CGRP levels in the blood have been linked to migraine and Articles by Meng, I. D.
Articles by Porreca, F.
elevated CGRP can be casued by prolonged sumatriptan exposure. Possible
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mechanisms that may be common to both migraine and MOH include increased Substance via MeSH
endogenous facilitation of pain and/or diminished diminished endogenous pain Medline Plus Health Information
inhibition. Neuroanatomical pathways mediating these effects are examined. Headache

Medication overuse headache allodynia pain headache opioids

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May 2011 31 (7)
triptans sensitization
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Received July 22, 2010.
Revision received January 13, 2011.
Accepted January 25, 2011.

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Preface to the Second Edition

Occipital nerve stimulation for
the treatment of intractable
chronic migraine headache:
ONSTIM feasibility study
15th Congress of the
International Headache Society
23-26 June 2011, Berlin,
Germany
Exercise as migraine
prophylaxis: A randomized
HOME ALL ISSUES FEEDBACK SUBSCRIBE RSS EMAIL ALERTS HELP studyISSN:
Print using0333-1024
relaxation and
topiramate as controls
Copyright © 2012 by International Headache Society Online ISSN:
Guidelines for1468-2982
controlled trials
of drugs in migraine: Third
edition. A guide for
investigators
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