Risk of development of medication overuse headache with nonsteroidal anti-inflammatory drug therapy for migraine: A critically appraised topic

Amaal Starling, Charlene Hoffman-Snyder, Rashmi B Halker Singh, Kay E. Wellik, Bert B. Vargas, David William Dodick, Bart M Demaerschalk, Dean Marko Wingerchuk

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: The development of medication overuse headache (MOH) is associated with frequent use of analgesics, especially opiates, for treatment of primary headache disorders, particularly migraine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat migraine. Objective: To critically evaluate evidence estimating the risk of MOH associated with NSAID therapy in patients with migraine. Methods: The objective was addressed through the development of a structured, critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and headache neurology content experts. Results: The 1-year incidence of MOH was 2.5%. In patients with low (0 to 4 d monthly) to moderate (5 to 9 d monthly) baseline headache frequency, NSAIDs were not associated with progression to MOH and may be protective (odds ratio=0.31; 95% confidence interval, 0.27-0.34). However, in patients with a high baseline headache frequency (10 to 14 d monthly), NSAIDs are associated with progression to MOH (odds ratio=1.93; 95% confidence interval, 1.82-2.06). Conclusions:: Acute NSAID therapy is associated with progression to MOH in migraineurs with a high baseline migraine frequency but may be protective in patients with low baseline headache frequency. However, a causal role for NSAIDs in progression from episodic to chronic headache has not been established.

Original languageEnglish (US)
Pages (from-to)297-299
Number of pages3
JournalNeurologist
Volume17
Issue number5
DOIs
StatePublished - Sep 2011

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Secondary Headache Disorders
Migraine Disorders
Anti-Inflammatory Agents
Drug Therapy
Headache
Pharmaceutical Preparations
Opiate Alkaloids
Odds Ratio
Primary Headache Disorders
Confidence Intervals
Librarians
Headache Disorders
Neurology
Consultants
Analgesics
Incidence

Keywords

  • critically appraised topic
  • evidence-based medicine
  • medication overuse headache
  • migraine disorders
  • nonsteroidal anti-inflammatory drugs

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

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title = "Risk of development of medication overuse headache with nonsteroidal anti-inflammatory drug therapy for migraine: A critically appraised topic",
abstract = "Background: The development of medication overuse headache (MOH) is associated with frequent use of analgesics, especially opiates, for treatment of primary headache disorders, particularly migraine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat migraine. Objective: To critically evaluate evidence estimating the risk of MOH associated with NSAID therapy in patients with migraine. Methods: The objective was addressed through the development of a structured, critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and headache neurology content experts. Results: The 1-year incidence of MOH was 2.5{\%}. In patients with low (0 to 4 d monthly) to moderate (5 to 9 d monthly) baseline headache frequency, NSAIDs were not associated with progression to MOH and may be protective (odds ratio=0.31; 95{\%} confidence interval, 0.27-0.34). However, in patients with a high baseline headache frequency (10 to 14 d monthly), NSAIDs are associated with progression to MOH (odds ratio=1.93; 95{\%} confidence interval, 1.82-2.06). Conclusions:: Acute NSAID therapy is associated with progression to MOH in migraineurs with a high baseline migraine frequency but may be protective in patients with low baseline headache frequency. However, a causal role for NSAIDs in progression from episodic to chronic headache has not been established.",
keywords = "critically appraised topic, evidence-based medicine, medication overuse headache, migraine disorders, nonsteroidal anti-inflammatory drugs",
author = "Amaal Starling and Charlene Hoffman-Snyder and {Halker Singh}, {Rashmi B} and Wellik, {Kay E.} and Vargas, {Bert B.} and Dodick, {David William} and Demaerschalk, {Bart M} and Wingerchuk, {Dean Marko}",
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T2 - A critically appraised topic

AU - Starling, Amaal

AU - Hoffman-Snyder, Charlene

AU - Halker Singh, Rashmi B

AU - Wellik, Kay E.

AU - Vargas, Bert B.

AU - Dodick, David William

AU - Demaerschalk, Bart M

AU - Wingerchuk, Dean Marko

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N2 - Background: The development of medication overuse headache (MOH) is associated with frequent use of analgesics, especially opiates, for treatment of primary headache disorders, particularly migraine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat migraine. Objective: To critically evaluate evidence estimating the risk of MOH associated with NSAID therapy in patients with migraine. Methods: The objective was addressed through the development of a structured, critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and headache neurology content experts. Results: The 1-year incidence of MOH was 2.5%. In patients with low (0 to 4 d monthly) to moderate (5 to 9 d monthly) baseline headache frequency, NSAIDs were not associated with progression to MOH and may be protective (odds ratio=0.31; 95% confidence interval, 0.27-0.34). However, in patients with a high baseline headache frequency (10 to 14 d monthly), NSAIDs are associated with progression to MOH (odds ratio=1.93; 95% confidence interval, 1.82-2.06). Conclusions:: Acute NSAID therapy is associated with progression to MOH in migraineurs with a high baseline migraine frequency but may be protective in patients with low baseline headache frequency. However, a causal role for NSAIDs in progression from episodic to chronic headache has not been established.

AB - Background: The development of medication overuse headache (MOH) is associated with frequent use of analgesics, especially opiates, for treatment of primary headache disorders, particularly migraine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat migraine. Objective: To critically evaluate evidence estimating the risk of MOH associated with NSAID therapy in patients with migraine. Methods: The objective was addressed through the development of a structured, critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and headache neurology content experts. Results: The 1-year incidence of MOH was 2.5%. In patients with low (0 to 4 d monthly) to moderate (5 to 9 d monthly) baseline headache frequency, NSAIDs were not associated with progression to MOH and may be protective (odds ratio=0.31; 95% confidence interval, 0.27-0.34). However, in patients with a high baseline headache frequency (10 to 14 d monthly), NSAIDs are associated with progression to MOH (odds ratio=1.93; 95% confidence interval, 1.82-2.06). Conclusions:: Acute NSAID therapy is associated with progression to MOH in migraineurs with a high baseline migraine frequency but may be protective in patients with low baseline headache frequency. However, a causal role for NSAIDs in progression from episodic to chronic headache has not been established.

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