Migraine and other types of headache may be so persistent and severe that the use of many medications for pain may actually cause headaches to worsen over time. This is classified as “medication overuse headache” (MOH) in the migraine medical literature.
Patients with over fifteen migraine headache days each month are classified as “chronic migraine”. The management of chronic migraine is significantly different from episodic migraine (less than fifteen days of migraine headache each month). One of the most important ways the management differs is in the need for migraine headache pain medication that will not worsen the headache severity and frequency over time.
For chronic migraine headache pain, medication that does not contribute to Medication Overuse Headache is recommended The reader should be reminded that all drugs when overused can be harmful and potentially fatal, but some are more troubling than others, and at least in moderate overuse patterns some are not likely to prompt the development of Medication Overuse Headache.
Preferred medications include:
Hydroxyzine (oral or parenteral)
Baclofen
Tizanidine
NSAIDs (p.o., IM, p.r.), especially naproxen and indomethacin.
Aspirin specifically, such as Trilisate
Neuroleptics (oral, p.r., parenteral)
Benzodiazepines (oral or parenteral)
Various muscle relaxants, including metaxalone and methocarbamol (which have a central effect).
(This list is adapted from the web site of the Michigan Head Pain and Neurological Institute, an excellent inpatient headache clinic whose link is posted above).
It can be difficult for the patient with chronic migraine to accept that some pain may be necessary to reduce migraine headache frequency. Pain receptors that are adapted to chronic pain medication can increase the sensitivity to pain over time; the experience of pain in medication withdrawal may be necessary for correction of this problem. Although pain medications may need to be limited or stopped completely, other treatments such as those above, and medications that induce relaxation or sleep, are often helpful during the period of pain medication withdrawal.
