Happiest New Year! May 2026 be free from the “Headache Grinch”- Medication Overuse Headache (MOH)
As a headache specialist, I consider the “Grinch” as somewhat a fitting metaphor for Medication Overuse Headache (MOH). At first, a “pain reliever” medication may seem like an hero, swooping in to valiantly save the day when a patient is plagued by agonizing headache. But use this type of medication improperly or too often, and with the impact of -boom- the very pounding pain one was initially fleeing, MOH may bite back as a stealthy turncoat that sticks the patient into a kettle of fish. Overall, MOH robs a patient of headache relief, thereby replacing it instead with headaches that are increasingly unresponsive to the migraine treatment that is actually indicated.
MOH spawns headache as the patient’s nervous system becomes dependent on pain medications, the wearing off of which can further perpetuate headaches with a vengeance. Counterintuitively as a patient takes increasing pills in attempts to alleviate, this fuels the vicious cycle.
Unfortunately, it does not take much to develop MOH, as it creeps on insidiously at a vulnerable time to a patient. This may be catalyzed by the fact that over-the-counter medications may be particularly welcoming to a patient: a friendlier and even safer seeming alternative given its convenient accessibility, as compared to prescription migraine medications. My patients commonly tell me that they only take over-the-counter medications as last resort - they tend to grit their teeth through suffering and stick it out for the purposes of avoiding medications altogether. In doing so, patients believe that they are indeed pursuing the most prudent approach.
Realistically, this hard stance may unwittingly sabotage the patient’s original quest for medication minimalism. Migraine prescriptions treat migraine at the root cause, as opposed to pain medications that are non-specific in indication, widely available for purchase over-the-counter, even sporting catchy labels advertising a simple fix. This often leads into high frequency overuse of over-the-counter meds. However with proper utilization, acute migraine prescription treatments with targeted efficacy may very likely improve headaches with significantly less medication intake.
MOH is a state of paradoxical rebound headache that is devastatingly widespread, caused by improper use of analgesics, which may include:
Use of opioids or butalbital-containing medications (i.e. butalbital-acetaminophen-caffeine) can activate MOH by the nature of drug pharmacology. Risks vs. benefits are important- to discontinue safely, patients need to be weaned off these medications by those providers prescribing for the patient in the first place, and/or by a speciality/setting i.e. pain management with the expertise to manage safe detoxification. This needs to be completed before headache specialist can effectively intervene.
Frequent use of over-the-counter pain medications: acetaminophen or NSAID use (greater than or equal to 10-15 days/month), depending on medication
Excessive use of even migraine medications i.e. triptans
How to get out of this pickle? Greener horizons lay ahead. We can absolutely do better!
With proper diagnoses and reliable support, MOH can be eradicated and the headache environment successfully restored to homeostasis. Seek medical advice, including a qualified headache specialist with expertise in migraines. A patient should be placed on the best appropriate treatment regimen. Empowered with guidance, the patient may continue to utilize medications such as over-the-counter pain medications and triptans in the form that is correctly clinically indicated, without increased risk of headaches.
Also, the takeaway to this post is not that the medications themselves comprise the “Grinch”, but the MOH itself, a notoriously common culprit that capitalizes on the basic mechanism in incorrect use of medications. Awareness is key for prevention. Removal of MOH is the first step towards achieving effective headache relief and reclaiming quality of life. Kick MOH to the curb and cheers to a brilliant New Year with less headaches and more happiness! Park Your Headache to reach this goal for 2026.
