Download PDF
Semin Neurol 2006; 26(2): 232-241
DOI: 10.1055/s-2006-939924
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Pathophysiology and Management of Transformed Migraine and Medication Overuse Headache

Christopher J. Boes1 , David F. Black1 , David W. Dodick2
  • 1Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
  • 2Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Arizona
Further Information

Publication History

Publication Date:
21 April 2006 (online)

    Permissions and Reprints

ABSTRACT

There is considerable overlap in the mechanisms mediating migraine headache pain and sustained opioid-induced paradoxical pain. Both involve upregulation of calcitonin gene-related peptide and increased excitability of dorsal horn neurons. Descending facilitation from the rostral ventromedial medulla may contribute to this increased excitability. Using special magnetic resonance imaging techniques, high iron levels were found in the periaqueductal gray of patients with chronic daily headache with medication overuse. The periaqueductal gray is the center of a powerful descending antinociceptive neuronal network and projects to the rostral ventromedial medulla and subsequently to the dorsal horn. The periaqueductal gray is also involved in the behavioral response to opiate withdrawal. Dysfunction in the periaqueductal gray may explain why frequent analgesic use can result in medication overuse headache in migraineurs. Management of transformed migraine with medication overuse involves patient education, biobehavioral therapy, withdrawal of overused acute medications, bridge therapy for withdrawal headache, initiation of preventive medication, and close follow-up.

KEYWORDS

Transformed migraine - chronic migraine - medication overuse headache - chronic daily headache

REFERENCES

  • 1 Boes C J, Capobianco D J. Chronic migraine and medication-overuse headache through the ages.  Cephalalgia. 2005;  25 378-390
    CrossrefPubMedGoogle Scholar
  • 2 Collier J. Diseases of the nervous system. In: Price FW A Textbook of the Practice of Medicine. London; Hodder and Stoughton 1922: 1502-1506
    Google Scholar
  • 3 Silberstein S D, Lipton R B, Sliwinski M. Classification of daily and near-daily headaches: field trial of revised IHS criteria.  Neurology. 1996;  47 871-875
    CrossrefPubMedGoogle Scholar
  • 4 Silberstein S D, Lipton R B, Solomon S, Mathew N T. Classification of daily and near-daily headaches: proposed revisions to the International Headache Society criteria.  Headache. 1994;  34 1-7
    PubMedGoogle Scholar
  • 5 Headache Classification Subcommittee of the International Headache Society . The international classification of headache disorders, 2nd edition.  Cephalalgia. 2004;  24(suppl 1) 1-160
    PubMedGoogle Scholar
  • 6 Bigal M E, Tepper S J, Sheftell F D, Rapoport A M, Lipton R B. Chronic daily headache: correlation between the 2004 and the 1988 International Headache Society diagnostic criteria.  Headache. 2004;  44 684-691
    CrossrefPubMedGoogle Scholar
  • 7 Meng I D, Porreca F. Mechanisms of medication overuse headache.  Headache Currents. 2004;  1 47-54
    CrossrefPubMedGoogle Scholar
  • 8 Bahra A, Walsh M, Menon S, Goadsby P J. Does chronic daily headache arise de novo in association with regular use of analgesics?.  Headache. 2003;  43 179-190
    CrossrefPubMedGoogle Scholar
  • 9 Welch K MA, Nagesh V, Aurora S K, Gelman N. Periaqueductal gray matter dysfunction in migraine: cause or the burden of illness?.  Headache. 2001;  41 629-637
    CrossrefPubMedGoogle Scholar
  • 10 Aurora S K. Imaging chronic daily headache.  Curr Pain Headache Rep. 2003;  7 209-211
    PubMedGoogle Scholar
  • 11 Goadsby P J, Gundlach A L. Localization of 3H-dihydroergotamine-binding sites in the cat central nervous system: relevance to migraine.  Ann Neurol. 1991;  29 91-94
    CrossrefPubMedGoogle Scholar
  • 12 Goadsby P J, Knight Y E. Direct evidence for central sites of action of zolmitriptan (311C90): an autoradiographic study in cat.  Cephalalgia. 1997;  17 153-158
    CrossrefPubMedGoogle Scholar
  • 13 Welch K MA, Goadsby P J. Chronic daily headache: nosology and pathophysiology.  Curr Opin Neurol. 2002;  15 287-295
    CrossrefPubMedGoogle Scholar
  • 14 Sheftell F D, Brunton S A, Coon T L, Hutchinson S L, Kaniecki R G. Chronic daily headache: understanding and treating a common malady.  Family Practice Recertification. 2004;  26 25-36
    PubMedGoogle Scholar
  • 15 Grazzi L, Andrasik F, D'Amico D et al.. Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years.  Headache. 2002;  42 483-490
    CrossrefPubMedGoogle Scholar
  • 16 Kudrow L. Paradoxical effects of frequent analgesic use. In: Critchley M, Friedman A, Goroni S, Sicuteri F Advances in Neurology. New York; Raven Press 1982: 335-341
    Google Scholar
  • 17 Mathew N T, Kurman R, Perez F. Drug induced refractory headache: clinical features and management.  Headache. 1990;  30 634-638
    CrossrefPubMedGoogle Scholar
  • 18 Dodick D W. Clinical practice: chronic daily headache.  N Engl J Med. 2006;  354 158-165
    CrossrefPubMedGoogle Scholar
  • 19 Katsarava Z, Fritsche G, Muessig M, Diener H-C, Limmroth V. Clinical features of withdrawal headache following overuse of triptans and other headache drugs.  Neurology. 2001;  57 1694-1698
    PubMedGoogle Scholar
  • 20 Freitag F G, Lake A, Lipton R, Cady R. on behalf of the US Headache Guidelines Consortium, Section on Inpatient Treatment, Chairpersons: Diamond S Silberstein S . Inpatient treatment of headache: an evidence-based assessment.  Headache. 2004;  44 342-360
    CrossrefPubMedGoogle Scholar
  • 21 Young W B. Treatment of medication overuse headache and long-term outcome.  Headache Currents. 2004;  1 55-59
    CrossrefPubMedGoogle Scholar
  • 22 Katsarava Z, Muessig M, Dzagnidze A, Fritsche G, Diener H-C, Limmroth V. Medication overuse headache: rates and predictors for relapse in a 4-year prospective study.  Cephalalgia. 2005;  25 12-15
    CrossrefPubMedGoogle Scholar
  • 23 Mathew N T. Amelioration of ergotamine withdrawal symptoms with naproxen.  Headache. 1987;  27 130-133
    CrossrefPubMedGoogle Scholar
  • 24 Krymchantowski A V, Barbosa J S. Prednisone as initial treatment of analgesic-induced daily headache.  Cephalalgia. 2000;  20 107-113
    CrossrefPubMedGoogle Scholar
  • 25 Pageler L, Katsarava Z, Limmroth V, Diener H-C. Prednisone in the treatment of medication withdrawal headache following medication overuse headache: a placebo-controlled, double-blind and randomized pilot study.  Cephalalgia. 2004;  24 792
    PubMedGoogle Scholar
  • 26 Raskin N H. Repetitive intravenous dihydroergotamine as therapy for intractable migraine.  Neurology. 1986;  36 995-997
    CrossrefPubMedGoogle Scholar
  • 27 Boes C J, Jones J M, Dodick D W. A retrospective study of self-administered subcutaneous dihydroergotamine in the outpatient treatment of chronic daily headache associated with medication overuse.  Headache. 2000;  40 402
    PubMedGoogle Scholar
  • 28 Silberstein S D, Schulman E A, Hopkins M M. Repetitive intravenous DHE in the treatment of refractory migraine.  Headache. 1990;  30 334-339
    CrossrefPubMedGoogle Scholar
  • 29 Silberstein S D, Silberstein J R. Chronic daily headache: long-term prognosis following inpatient treatment with repetitive IV DHE.  Headache. 1992;  32 439-445
    CrossrefPubMedGoogle Scholar
  • 30 Silberstein S D, Young W B. for the Working Panel of the Headache and Facial Pain Section of the American Academy of Neurology . Safety and efficacy of ergotamine tartrate and dihydroergotamine in the treatment of migraine and status migrainosus.  Neurology. 1995;  45 577-584
    PubMedGoogle Scholar
  • 31 Ford R G, Ford K T. Continuous intravenous dihydroergotamine in the treatment of intractable headache.  Headache. 1997;  37 129-136
    CrossrefPubMedGoogle Scholar
  • 32 Raskin N H. Modern pharmacotherapy of migraine.  Neurol Clin. 1990;  8 857-865
    PubMedGoogle Scholar
  • 33 Mathew N T, Kailasam J. Repetitive intravenous administration of valproate sodium in intractable migraine: comparison with intravenous dihydroergotamine (DHE).  Neurology. 2000;  54(suppl 3) A22
    PubMedGoogle Scholar
  • 34 Schwartz T H, Karpitskiy V V, Sohn R S. Intravenous valproate sodium in the treatment of daily headache.  Headache. 2002;  42 519-522
    CrossrefPubMedGoogle Scholar
  • 35 Lu S-R, Fuh J-L, Juang K-D, Wang S-J. Repetitive intravenous prochlorperazine treatment of patients with refractory chronic daily headache.  Headache. 2000;  40 724-729
    CrossrefPubMedGoogle Scholar
  • 36 Rozen T D. Migraine headache: immunosuppressant therapy.  Curr Treat Options Neurol. 2002;  4 395-401
    PubMedGoogle Scholar
  • 37 Young W B. Medication overuse headache.  Curr Treat Options Neurol. 2001;  3 181-188
    PubMedGoogle Scholar
  • 38 Silberstein S D, Lipton R B, Goadsby P J. Tension-type headache: diagnosis and treatment. In: Silberstein SD, Lipton RB, Goadsby PJ Headache in Clinical Practice. 2nd ed. London; Martin Dunitz 2002: 113-128
    Google Scholar
  • 39 Redillas C, Solomon S. Prophylactic pharmacological treatment of chronic daily headache.  Headache. 2000;  40 83-102
    CrossrefPubMedGoogle Scholar
  • 40 Bonuccelli U, Nuti A, Lucetti C, Pavese N, Dell'Agnello G, Muratorio A. Amitriptyline and dexamethasone combined treatment in drug-induced headache.  Cephalalgia. 1996;  16 198-200
    PubMedGoogle Scholar
  • 41 Hering R, Steiner T J. Abrupt outpatient withdrawal of medication in analgesic-abusing migraineurs.  Lancet. 1991;  337 1442-1443
    CrossrefPubMedGoogle Scholar
  • 42 Krymchantowski A V, Silva M T, Barbosa J S, Alves L A. Amitriptyline versus amitriptyline combined with fluoxetine in the preventative treatment of transformed migraine: a double-blind study.  Headache. 2002;  42 510-514
    CrossrefPubMedGoogle Scholar
  • 43 Mathew N T. Prophylaxis of migraine and mixed headache: a randomized controlled study.  Headache. 1981;  21 105-109
    CrossrefPubMedGoogle Scholar
  • 44 Saper J R, Silberstein S D, Lake A E, Winters M E. Double-blind trial of fluoxetine: chronic daily headache and migraine.  Headache. 1994;  34 497-502
    CrossrefPubMedGoogle Scholar
  • 45 Saper J R, Lake A E, Tepper S J. Nefazodone for chronic daily headache prophylaxis: an open-label study.  Headache. 2001;  41 465-474
    CrossrefPubMedGoogle Scholar
  • 46 Mathew N T, Ali S. Valproate in the treatment of persistent chronic daily headache: an open label study.  Headache. 1991;  31 71-74
    CrossrefPubMedGoogle Scholar
  • 47 Rothrock J F, Kelly N M, Brody M L, Golbeck A. A differential response to treatment with divalproex sodium in patients with intractable headache.  Cephalalgia. 1994;  14 241-244
    CrossrefPubMedGoogle Scholar
  • 48 Siva A, Altintas A, Kantarci O et al.. Sodium valproate treatment of chronic daily headache.  Cephalalgia. 1997;  17 460-461
    PubMedGoogle Scholar
  • 49 Freitag F G, Diamond S, Diamond M L, Urban G J. Divalproex in the long-term treatment of chronic daily headache.  Headache. 2001;  41 271-278
    CrossrefPubMedGoogle Scholar
  • 50 Spira P J, Beran R G. for the Australian Gabapentin Chronic Daily Headache Group . Gabapentin in the prophylaxis of chronic daily headache: a randomized, placebo-controlled study.  Neurology. 2003;  61 1753-1759
    PubMedGoogle Scholar
  • 51 Silvestrini M, Bartolini M, Coccia M, Baruffaldi R, Taffi R, Provinciali L. Topiramate in the treatment of chronic migraine.  Cephalalgia. 2003;  23 820-824
    CrossrefPubMedGoogle Scholar
  • 52 Shuaib A, Ahmed F, Muratoglu M, Kochanski P. Topiramate in migraine prophylaxis: a pilot study.  Cephalalgia. 1999;  19 379-380
    PubMedGoogle Scholar
  • 53 Mathew N T, Kailasam J, Meadors L. Prophylaxis of migraine, transformed migraine, and cluster headache with topiramate.  Headache. 2002;  42 796-803
    CrossrefPubMedGoogle Scholar
  • 54 Pascual J, Sanchez del Rio M, Mateos V et al.. Topiramate for patients with refractory migraine: an observational, multicenter study in Spain.  Neurologia. 2003;  18 364-367
    PubMedGoogle Scholar
  • 55 Saper J R, Lake A E, Cantrell D T, Winner P K, White J R. Chronic daily headache prophylaxis with tizanidine: a double-blind, placebo-controlled, multicenter outcome study.  Headache. 2002;  42 470-482
    CrossrefPubMedGoogle Scholar
  • 56 Mathew N T. Chronic daily headache. In: Evans RW, Mathew NT Handbook of Headache. 2nd ed. Philadelphia; Lippincott Williams and Wilkins 2005: 113-138
    Google Scholar
  • 57 Blumenfeld A M, Dodick D W, Silberstein S D. Botulinum neurotoxin for the treatment of migraine and other primary headache disorders.  Dermatol Clin. 2004;  22 167-175
    PubMedGoogle Scholar
  • 58 Tepper S J, Bigal M E, Sheftell F D, Rapoport A M. Botulinum neurotoxin type A in the preventive treatment of refractory headache: a review of 100 consecutive cases.  Headache. 2004;  44 794-800
    CrossrefPubMedGoogle Scholar
  • 59 Ondo W G, Vuong K D, Derman H S. Botulinum toxin A for chronic daily headache: a randomized, placebo-controlled, parallel design study.  Cephalalgia. 2004;  24 60-65
    CrossrefPubMedGoogle Scholar
  • 60 Frishberg B M, Mathew N T, Gawel M, Dimitrova R, Gibson J, Turkel C. Botulinum toxin type A for the prophylactic treatment of chronic daily headache: a randomized, double-blind, placebo-controlled trial.  Neurology. 2005;  64(suppl 1) A422
    PubMedGoogle Scholar
  • 61 Dodick D W, Mauskop A, Elkind A H, DeGryse R, Brin M F, Silberstein S D. Botulinum toxin type A for the prophylaxis of chronic daily headache: subgroup analysis of patients not receiving other prophylactic medications (a randomized double-blind, placebo-controlled study).  Neurology. 2005;  64(suppl 1) A422
    PubMedGoogle Scholar
  • 62 Saper J R, Lake A E, Hamel R L et al.. Daily scheduled opioids for intractable head pain: long-term observations of a treatment program.  Neurology. 2004;  62 1687-1694
    PubMedGoogle Scholar
  • 63 Diener H-C, Katasarva Z. Analgesic/abortive overuse and misuse in chronic daily headache.  Curr Pain Headache Rep. 2001;  5 545-550
    PubMedGoogle Scholar

Christopher J BoesM.D. 

Department of Neurology, Mayo Clinic College of Medicine

200 First Street SW, Rochester, MN 55906