Could You Have Medication Overuse Headache?

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Key Questions
  • What is medication overuse headache (MOH)?
  • What are the symptoms of MOH?
  • What medications and/or treatments will or will not cause MOH?
  • How does someone with MOH break the cycle?
  • What role do preventives play in MOH?
  • How long is the average withdrawal period when trying to break the MOH cycle?
  • How do you adhere to the theory of “treat early” while still trying to avoid MOH?
  • Why are women more prone than men to experiencing MOH?
  • How can a headache diary aid in avoiding MOH?
Interview Notes
Treatments Mentioned
  • CGRP receptor antagonists (gepants)
  • Ditans (selective 5HT1F receptor agonists)
  • Ergotamines
  • Neuromodulation devices
  • NSAIDs
  • OnabotulinumtoxinA (Botox)
  • Opioids
  • Triptans

Please note: The Migraine World Summit’s aim is to bring you a variety of perspectives and expertise, independent of bias or judgment. Alternative theories presented in this video have not been medically reviewed. Views expressed in this interview do not necessarily represent the views of the Migraine World Summit. Please always consult your health care professional and do your own research before making changes to your treatment plan.

Gisela Terwindt, MD, PhD

Professor of Neurology
Leiden University Medical Center, Netherlands

Dr. Gisela Terwindt is consultant neurologist and director of the Leiden Headache Center at the Leiden University Medical Center, Netherlands. She is chair of the Scientific and Headache Guideline Committee of the Dutch Headache Society, chair of the International Headache Society (IHS) Clinical Trial Guideline Committee, and chair of the IHS Women’s Leadership Forum. She has also participated as a member of the IHS committee in preparing the International Classification of Headache Disorders (ICHD-3).

Her research focuses on neurobiological and molecular triggering mechanisms that lead up to migraine attacks in order to identify treatment targets for the prevention of attacks and disease progression. Her group is also studying the pathogenesis of monogenic disorders such as hemiplegic migraine and cerebral hereditary angiopathies, which serve as models for migraine pathogenesis and help improve insight into the pathophysiology of common neurovascular disorders, including stroke and vascular dementia. Dr. Terwindt is involved in exploring the migraine–stroke relationship, with a special focus on female-specific triggers for migraine and stroke. She has published over 350 scientific papers and received a prestigious personal grant from the Dutch Research Council.

Dr. Terwindt received her master of science degree in biology and her doctor of medicine degree at the University of Leiden, Netherlands. Her PhD research centered on the epidemiology and genetics of migraine and resulted in the discovery of the first migraine gene.

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