Chronic daily headache and

MOH
CDH
• Presence of headache on at least 15 days/month for at least 3 months
• Need secondary etiologies excluded (esp imaging)
Primary CDH
• Short duration CDH (< 4 hours)
• Chronic cluster headache
• Others TACs (Chronic PH, SUNCT, SUNA)
• Hypnic headache
• Long duration CDH (> 4 hours)
• Chronic migraine
• Chronic tension type headache
• Hemicrania continua
• New daily persistent headache
MOH
• Rebound headache, drug-induced headache, medication-misuse
headache
• Patients with a pre-existing primary headache who, in association
with medication overuse, develop a new type of headache or a
marked worsening of their preexisting headache
Diagnostic criteria
A. Headache occurring on 15 days per month in a patient with a pre-
existing headache disorder

B. Regular overuse for >3 months of one or more drugs that can be
taken for acute and/or symptomatic treatment of headache

C. Not better accounted for by another ICHD-3 diagnosis

Medication
• Ergotamine, Triptan, Opioid, Combination-analgesic, Multiple drug
classes not individually overused, Unverified overuse of multiple drug
classes, other medication (≥10 days per month for >3 months)
• Paracetamol, Acetylsalicylic acid, NSAIDs (≥15 days per month for >3
months)
MOH
• Secondary headache
• Underlying headache is migraine > tension-type headache > other
primary headache disorder, such as cluster headache
• Patients with episodic headache who overuse pain medications for
reasons other than headache can also develop MOH
• Headache usually resembles the pre-existing headache
MOH
• Prevalence in general population = 0.5-2.6%
• Risk factors
• primary headache disorders (migraine, tension-type headache)
• female sex
• >10 headache days monthly
• other chronic pain conditions
• lower socioeconomical status
• dependency behavior
• comorbid psychiatric disorders
• Pathophysiology is still not fully understood
MOH
• Treatment
• Withdrawal of MOH-inducing medication
• Abrupt versus taper off
• Preventive therapy
• Chronic migraine with MOH -> Topiramate and
onabotulinum toxin A
• Adding preventive medication to early
discontinuation led to a better outcome
• Management of withdrawal-associated
symptoms
• Transient deterioration of the underlying
headache, autonomic disturbances, anxiety and
sleep problems
• Fluid replacement and pharmacological
treatments, including corticosteroids,
neuroleptic drugs, tranquilizers, ergotamines
and simple analgesics (Rescue therapy)
MOH
• Relapse
• Migraine headache, overused triptans had fewer relapses
• Chronic tension-type headache, overuse of opioids and comorbid psychiatric
disorders had higher relapses