Chronic migraine and medication overuse: Still a debate

Progressive headache consequent to drug overuse is an old critical issue. Migraine specially and the development of its daily or near-daily presentation due to overuse of immediate-relief medications is suggested since the eighties when Mathew and col. described this transformation and named it transformed migraine. These authors called the attention for the fact that migraine may progressively transform into daily headache and lose its typical clinical features under the influence of analgesic overuse. Almost simultaneously, Kudrow demonstrated an improvement in attack frequency in those patients able to withdraw from this pattern of drug consumption. Even before that, ergotamine tartrate was associated with dependence and withdrawal headaches introducing the term rebound and postulating that all ergots could promote increasing of headache frequency. Other researchers and clinicians have been demonstrating that migraineurs may develop daily or near-daily headache when using excessively caffeine, opioids, triptans and analgesics, even for purposes other than headache, and that improvement in the frequency of headache attacks occurs following abrupt discontinuation with the patients restoring the initial episodic presentation of their head pain.

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