Medication Overuse Headache in Children

If your child has a history of frequent headaches that require the use of acetaminophen or ibuprofen for a minimum of 15 days per month for a period of at least 3 months then your child meets the criteria for medication overuse headache (MOH).  This is a common problem for many adolescents who are prone to take medication without adult supervision to relieve head pain. This places them at risk to have worsening symptoms over time due to inadequate initial treatment and a subsequent exacerbation of head pain due to rebound symptoms.

To limit the overuse of analgesic medication a thorough headache diary or log should be kept and all medication used needs to be documented. The best treatment is to prevent the overuse of medication before it happens. If your child or teen is already taking too much medication then education and a careful withdrawal of medication is necessary with medication changes as needed.

Providing correct information to parents is essential as is psychological support for both parents and the child. Transitional therapy may be necessary to help relieve symptoms and the use of prophylactic medication if the headache description suggests an underlying primary headache disorder such as childhood migraine.  Care must be taken to make sure there are no associated psychiatric or substance use disorders including anxiety and depression.

When you understand medication can worsen head pain you and your child will be better able to understand why the medication needs to be stopped as soon as possible and a new treatment plan initiated. Throughout this changeover it is important to monitor your child’s response and monitor progress in terms of pain and other associated symptoms.

Patient education before overuse becomes a problem is the best policy. If medication is being used beyond routine analgesics then inpatient monitoring may be necessary in order to manage symptoms and head pain recurrence.  For medication such as ibuprofen the use of a tapering dose of long acting non-steroidal anti-inflammatory drug (NSAID) can be helpful along with initiation of a preventive medication. Specific bridge or transitional medications will depend on the type of headache and the type of overused medication.

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