Silvia Ussai

By Silvia Ussai and Alessandro Rizzardo

Medication-overuse headache (MOH) is a worldwide health problem with a prevalence of 1–2%. It is a severe form of headache where the patients often have a long history of unsuccessful headache treatments. MOH is characterized by chronic headache and the overuse of different headache medications. Through the years, withdrawal of the overused medication has been recognized as the treatment of choice. However, currently, there is no clear consensus regarding the optimal strategy for the management of MOH. Treatment approaches are based on expert opinion rather than scientific evidence. This chapter focuses on an overall discussion of medication abuse as a novel pain pathway in headaches.

Part of the book: Pain Relief

By Silvia Ussai

Analgesics, the cornerstone for the alleviation of both acute and chronic pain, represent one of the most used classes of medications. While they are essential for the improvement of patients’ quality of life, analgesic use is often associated with adverse drug reactions (ADRs) that might affect their usability in particular clinical situations. This indicates that a detailed knowledge of analgesic‐derived ADRs is essential for the planning of an efficient pain relief strategy. This chapter reviews the ADRs associated with the two most commonly used analgesic classes, opioid and nonsteroidal anti‐inflammatory drugs (NSAID), discussing their common adverse effects and how these can influence their usability in clinical applications. With the publication in recent years of more and more long‐term studies, this chapter also provides an overview of the potential risks of long‐term analgesic use. This is particularly important for opioid analgesics, whose chronic use can lead to analgesic tolerance and addiction. A full description of potential problems deriving from analgesic use represents the first step in optimizing protocols for its safe application in clinical settings.

Part of the book: Pain Relief