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Medication-overuse headache and opioid-induced hyperalgesia: A review of mechanisms, a neuroimmune hypothesis and a novel approach to treatment

Cephalalgia, ISSN: 0333-1024, Vol: 33, Issue: 1, Page: 52-64
2013
  • 41
    Citations
  • 0
    Usage
  • 70
    Captures
  • 2
    Mentions
  • 5
    Social Media
Metric Options:   Counts1 Year3 Year

Metrics Details

  • Citations
    41
  • Captures
    70
  • Mentions
    2
    • References
      2
      • Wikipedia
        2
  • Social Media
    5
    • Shares, Likes & Comments
      5
      • Facebook
        5

Review Description

Introduction: Patients with chronic headache who consume large amounts of analgesics are often encountered in clinical practice. Excessive intake of analgesics is now considered to be a cause, rather than simply a consequence, of frequent headaches, and as such the diagnosis medication-overuse headache (MOH) has been formulated. Despite the prevalence and clinical impact of MOH, the pathophysiology behind this disorder remains unclear and specific mechanismbased treatment options are lacking. Discussion: Although most acute headache treatments have been alleged to cause MOH, here we conclude from the literature that opioids are a particularly problematic drug class consistently associated with worsening headache. MOH may not be a single entity, as each class of drug implicated may cause MOH via a different mechanism. Recent evidence indicates that chronic opioid administration may exacerbate pain in the long term by activating toll-like receptor-4 on glial cells, resulting in a pro-inflammatory state that manifests clinically as increased pain. Thus, from the available evidence it seems opioid-overuse headache is a phenomenon similar to opioid-induced hyperalgesia, which derives from a cumulative interaction between central sensitisation, due to repeated activation of nociceptive pathways by recurrent headaches, and pain facilitation due to glial activation. Conclusion: Treatment strategies directed at inhibiting glial activation may be of benefit alongside medication withdrawal in the management of MOH. © International Headache Society 2012.

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