Medication-Overuse Headache (MOH) Treatment in Ottawa

Medication-overuse headache occurs when the brain becomes sensitized by frequent use of acute headache medications. Instead of relieving headaches, the medications begin to maintain or worsen them.

Over time:

• Headaches become more frequent

• Medications work less well

• Pain returns sooner after each dose

This creates a self-reinforcing cycle.

A common story of someone with medication-overuse headache is that of:

• Someone who initially had episodic headache attacks

• With time acute treatments were needed more frequently to manage headache

• A daily dull featureless headache appeared

• Headache attacks became more resistant to acute medications

Typically, the diagnosis of medication-overuse headache is made when a person with a pre-existing headache disorder (e.g., migraine) experiences headache for more than half of the month (i.e., at least 15 days per month) and acute medications have been used beyond their limits.

Our approach at the Ottawa Headache Centre

The most effective treatment is stopping the overused medication.

This can be done either abruptly (typically preferred) or gradually.

When stopping the overused medication, it is critical to have an alternative acute medication that you can use safely. For many patients, we will also recommend starting a daily preventive medication to lower headache frequency, intensity, and duration.

Our approach focuses on:

• Confirming the diagnosis and identifying the underlying primary headache disorder.

• Developing a safe medication withdrawal plan (abrupt or gradual depending on the medication).

• Providing bridge strategies to manage symptoms during withdrawal (e.g., gepants).

• Optimizing preventive treatment to reduce headache frequency long term.

The goal is not simply to stop medication. The goal is to restore control.

Preventive treatments that can help you while you stop the culprit acute medication

Starting or optimizing preventive headache treatment is crucial to effectively treat medication-overuse headache.

Preventives treatments help reduce headache frequency, reduce the need for acute medications, and prevent relapse.

Example of preventive treatments include:

• Blood pressure medications

• Antidepressants

• Anti-seizure medications

• CGRP antagonists

• Botox®

• Nerve blocks

Next steps

If this pattern sounds familiar:

• Track your headache days and medication use

• Review your monthly medication frequency

• Speak with your doctor or nurse practitioner about referral to a headache specialist.

Medication-overuse headache is common. It is reversible.

And with the right strategy, the cycle can be broken.

Disclaimer

This material is provided for educational purposes and does not replace independent clinical judgment or institutional protocols. Management decisions remain the responsibility of the treating clinician.