Medications That Make Migraine Worse

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Key Questions
  • What is the definition of medication overuse headache (MOH)?
  • Can pain medication make migraine worse?
  • Which migraine drugs are most likely to contribute to MOH?
  • Can MOH be caused by non-migraine-related drugs?
  • Which non-migraine drugs contribute to MOH?
  • Can MOH be caused by over-the-counter medications like NSAIDs or cold medications?
  • Can MOH be caused by an overuse of a combination of different drugs?
  • Are there any drugs that do not contribute to MOH?
  • Can MOH contribute to someone developing chronic migraine?
  • Are there risk factors outside of medication that contribute to MOH?
  • How might MOH differ from a regular migraine attack, if at all?
  • How do you know if you have MOH?
  • Does caffeine contribute to MOH?
  • Should butalbital be taken off the market?
  • Does undertreatment of migraine increase MOH?
  • How do you strike a balance between undertreatment and overtreatment?
  • What has changed in the past three years in the MOH treatment space?
  • How have the new CGRP drugs changed the outlook for MOH?
  • How can advocacy help reduce the occurrence of MOH across the population?
  • Are there any nonpharmacological ways to break MOH?
  • Does proper acute treatment of episodic migraine reduce the probability of having MOH?
Interview Notes

Stewart J. Tepper, MD

Professor of Neurology
Geisel School of Medicine at Dartmouth

Stewart J. Tepper, MD, is a professor of neurology at the Geisel School of Medicine at Dartmouth College in Hanover, New Hampshire. He is director of the Dartmouth Headache Center in the Department of Neurology of Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. Dr. Tepper received his undergraduate degree (graduating cum laude) in the study of the nervous system/psychobiology from Yale College, New Haven, Connecticut; and attended Cornell University Medical College in New York City. He completed his neurology residency at the Longwood Area Harvard program in Boston, Massachusetts, and has been board certified in headache medicine since 2006.

Dr. Tepper was director of the American Headache Society’s (AHS) Scottsdale Headache Symposium CME course from 2008 to 2020. He was editor-in-chief of the journal Headache Currents and associate editor of the journal Headache from 2012-2020. He has published more than 460 peer-reviewed manuscripts, editorials, and books on headache medicine. Dr. Tepper serves on the executive board of directors and is the corporate liaison for the AHS. He serves on the AHS Education, Exhibits, and Finance committees. For the American Migraine Foundation, he serves on the Governance Committee and board of directors.

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