Medication-Overuse Headache Prevention and Management

Risk Factors and Prevention

• The American College of Physicians recommends limiting use of any acute migraine medication, including those containing barbiturates, caffeine, butalbital, or opioids, to fewer than 10-15 days per month to minimize the risk of medication-overuse headache 1, 2
• The American Academy of Family Physicians suggests considering preventive migraine therapy if headaches occur more than 2 days per week, and using a headache diary to monitor frequency of medication use 2, 5
• Medications containing barbiturates, caffeine, butalbital, or opioids carry the highest risk of causing rebound headaches, while NSAIDs (when used less than 15 days/month) carry a lower risk, and newer CGRP antagonists like Ubrelvy have minimal evidence of risk 1, 3, 4

Management Approaches

• Individual response to medications varies significantly, and treatment should be tailored based on headache characteristics, frequency, and associated symptoms, according to the American College of Physicians 1, 2