Medication overuse and drug addiction: a narrative review from addiction perspective

• Main Authors: Tatiane Teru Takahashi, Raffaele Ornello, Giuseppe Quatrosi, Angelo Torrente, Maria Albanese, Simone Vigneri, Martina Guglielmetti, Cristiano Maria De Marco, Camille Dutordoir, Enrico Colangeli, Matteo Fuccaro, Davide Di Lenola, Valerio Spuntarelli, Laura Pilati, Salvatore Di Marco, Annelies Van Dycke, Ramla Abuukar Abdullahi, Antoinette Maassen van den Brink, Paolo Martelletti, on behalf of the European Headache Federation School of Advanced Studies (EHF AS)
• Format: Article
• Language: English
• Published: BMC 2021-04-01
• Series: The Journal of Headache and Pain
• Subjects: Drug abuse; Dependence; Migraine; Substance abuse; Vulnerability
• Online Access: https://doi.org/10.1186/s10194-021-01224-8

Abstract Chronic headache is particularly prevalent in migraineurs and it can progress to a condition known as medication overuse headache (MOH). MOH is a secondary headache caused by overuse of analgesics or other medications such as triptans to abort acute migraine attacks. The worsening of headache symptoms associated with medication overuse (MO) generally ameliorates following interruption of regular medication use, although the primary headache symptoms remain unaffected. MO patients may also develop certain behaviors such as ritualized drug administration, psychological drug attachment, and withdrawal symptoms that have been suggested to correlate with drug addiction. Although several reviews have been performed on this topic, to the authors best knowledge none of them have examined this topic from the addiction point of view. Therefore, we aimed to identify features in MO and drug addiction that may correlate. We initiate the review by introducing the classes of analgesics and medications that can cause MOH and those with high risk to produce MO. We further compare differences between sensitization resulting from MO and from drug addiction, the neuronal pathways that may be involved, and the genetic susceptibility that may overlap between the two conditions. Finally, ICHD recommendations to treat MOH will be provided herein.