It is a condition that occurs in a large number of people with frequent headaches — so there is also a lot of experience that the symptoms can improve with the right treatment.

There is a risk of developing MOH if you have used the following for 3 months:

• Migraine medication taken more than 10 days per month (triptans)
• Over-the-counter pain relievers more than 15 days a month (paracetamol, ibuprofen, etc.)
• Morphine-like agents or combination preparations on 10 days or more per month (e.g. codeine, tramadol, or combination painkillers such as APC tablets).
• A combination of the above medication types for a total of more than 9 days per month

What are the symptoms of medication overuse headache?

You get more frequent and more severe headaches. The medication works less well. If you have multiple types of headaches, they can be harder to tell apart.

You may wake up in the morning with a headache, nausea, a sense of malaise, and a heavy head. This often decreases after you take medication.

You may also find that you are less able to cope than before and that your quality of life has decreased.

What is the treatment for medication overdose headaches?

MOH's treatment consists of medication remediation, which means that you don't take painkillers for two to three months — neither for headaches nor for other pain symptoms.

The purpose of this break is to make your headache sensitive to treatment again, by breaking the vicious cycle of increasing headaches and growing medication use. Keep in mind that the headache may actually get worse in the first 2 to 3 weeks. This is a sign that your body is reeling.

Many people experience overall better well-being over time.

If you use medication for asthma, heart disease or other conditions, for example, you should of course keep taking it. Your doctor (or possibly neurologist) will discuss with you which medications you should keep taking and which ones you should temporarily stop.

What to expect?

In the first 2 to 3 weeks, you may notice that the headache worsens. You may also have flu-like symptoms or sleep problems.

When stopping opioids, you may experience diarrhea, fever, heart palpitations, sweating, and body and leg turmoil.

In some people, the headache remains unchanged and in a few it may worsen. Usually, however, the symptoms subside after a few weeks and the headache becomes less frequent and less intense.

Some people also feel more energetic when they don't take medication regularly.

It can help you prepare for medication remediation:

• Choose a date for you to stop taking headache medication and remove any medication from home
• Inform family and friends that you are going through a period without medication and what they can and cannot expect from you — they may be able to support you
• Limit obligations and agreements during this period
• Consider (partial) reporting sick and possibly discuss this with your employer

Pain relief without medication

• Try what normally helps (without medication) when you have a headache
• Rest and regularity: Keep a steady rhythm in your sleep and meals.
• Take time to take good care of yourself
• Sufficient fluids: Drink plenty of water (at least 1.5 to 2 liters) spread throughout the day.
• Limit caffeine: Be moderate with coffee, tea, and caffeinated soft drinks.
• Relaxation: Use warm or cold compresses on your head as it provides relief.
• Exercise: Get daily exercise in the fresh air, such as walking or cycling, and possibly do light relaxation or stretching exercises.
• Distraction: Find activities that you enjoy to shift the focus of the pain.

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Prevent it from coming back

When the withdrawal period is over and you are allowed to use painkillers occasionally again, strictly follow the “10-day rule” per month (for triptans and strong painkillers) or the “15-day rule” per month (for common pain relievers) to prevent the medication overdose headache from recurring. It can help to put a cross or number in the calendar for each use on the days that medication is used.

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