Headache Medicine 2021, 12(1):263 p-ISSN 2178-7468, e-ISSN 2763-6178
263
ASAA
DOI: 10.48208/HeadacheMed.2021.38
Headache Medicine
© Copyright 2021
Correspondence
Analgesic abuse headache: risk factors and causes of poor
adherence in the detox process
Thaiza Agostini Córdoba de Lima
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Dear Editor,
Medication overuse headache is considered a secondary headache developed in patients with
previous primary headache. Although there are well-established diagnostic criteria in ICHD-3
1
, this
condition involves points of divergence among headache specialist. In this letter, I would like to
criticize the use of the term abuse for this condition.
The terms overuse and abuse cannot be applied synonymously. Abuse is related to Substance Use
Disorders (SUD) diagnosed according to Diagnostic and Statistical Manual of Mental Disorders-5
(DSM-5).
2
The term “abuse” span a wide variety of problems arising from substance use, and cover
11 different criteria:
1. Taking the substance in larger amounts or for longer than you are meant to.
2. Wanting to cut down or stop using the substance but not managing to.
3. Spending a lot of time getting, using, or recovering from use of the substance.
4. Cravings and urges to use the substance.
5. Not managing to do what you should at work, home, or school because of substance use.
6. Continuing to use, even when it causes problems in relationships.
7. Giving up important social, occupational, or recreational activities because of substance use.
8. Using substances again and again, even when it puts you in danger.
9. Continuing to use, even when you know you have a physical or psychological problem that could
have been caused or made worse by the substance.
10. Needing more of the substance to get the effect you want (tolerance).
11. Development of withdrawal symptoms, which can be relieved by taking more of the substance.
As for the term “overuse”, although the terminology is widely used, there is no clear denition. The
current diagnostic criteria for medication overuse headache (MOH) is based on an arbitrary limit
of medication intake, this denition was based on expert opinion as there is no evidence based
on clinical studies.
Thus, term “abuse” cannot, according to its denition, be used in the condition of headache caused
by frequent use of medication.
Thaiza Agostini Córdoba de Lima
https://orcid.org/0000-0001-6694-5259
References
1. The International Classification of Headache Disorders, 3rd edition (beta version).
Cephalalgia
2013;33(9):629-808 Doi:10.1177/0333102413485658
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Porto Alegre:
Ar tmed; 2013.
thaiza_lima2@hotmail.com
Received: November 8, 2021
Accepted: November 16, 2021
Keywords:
Medication overuse headache
Substance use disorders