Medication Overuse Headache: Type I and Type II

Abstract

Dear Sir Our continuing experience with a complex population of patients suffering from medication overuse headache (MOH) prompts us to re-emphasize a point made in our earlier publication regarding the biobehavioural features of MOH (1). Many patients who overuse medications in pursuit of headache control are burdened by various neuropsychiatric and behavioural disturbances that we believe underlie the overuse behaviour. These include Axis I disorders, such as anxiety, depression, and others, as well as Axis II conditions, which include personality disorders, such as borderline (2), narcissistic, antisocial, and others (3). In other patients the overuse does not seem related to psychological dynamics. One of the many challenges in treating patients with MOH is to determine the presence or absence of confounding factors related to the medication overuse.

Many years of experience treating this population of patients lead us to believe that it would serve both treatment strategy development and treatment outcome success to classify MOH into two subtypes. Type I MOH would refer to relatively uncomplicated MOH cases: the overuse of a non-opioid/barbiturate-containing medication and the absence of significant, confounding behavioural disturbances. Type II MOH would be characterized by complicating factors: the overuse of opioid/barbiturate-containing medications and/or influential behavioural accompaniments.

We and others believe that the treatment challenges, therapeutic strategies and prognosis are significantly affected by these complicating variables (4, 5). The distinction that we propose would assist in proper triage and the development of the most effective treatment strategies. Medication overuse most certainly involves receptor and other central changes. We believe that many cases are also burdened by neurobehavioural phenomena that promote the overuse tendency and prompt recidivism. In the end, distinguishing less complicated cases from confounded ones will probably achieve more satisfactory outcomes and less recidivism.

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