Calcitonin gene-related peptide monoclonal antibodies and medication-overuse headache - stopping excessive pain medication is still necessary

Sep 29, 2026

Uploaded by Himbo

Medication-overuse headache affects 1–2% of the global population and is commonly linked to chronic migraine, substantially harming patients’ and families’ daily lives while driving economic burden through medical costs and lost productivity. This narrative review, part of a debate, argues that changing the pattern of symptomatic pain-medication overuse remains essential. It diagnoses medication-overuse headache by worsening headache characteristics with regular symptomatic drug use and critically reviews related literature and evidence.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Medication-overuse headache

Diagnosis and epidemiology

Pathophysiology and neuroimaging findings

Clinical heterogeneity

Reversal strategies and outcomes

Relapse considerations

Article published online: 2025-07-28 Point of View 1 Calcitonin gene-related peptide monoclonal antibodies and medication-overuse headache: stopping excessive pain medication is still necessary Pedro Augusto Sampaio Rocha-Filho 1,2 1 Universidade Federal de Pernambuco, Centro de Ciências Médicas,Área Acadêmica de Neuropsiquiatria, Recife PE, Brazil. 2 Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Serviço de Neurologia, Recife PE, Brazil. Arq. Neuro-Psiquiatr. 2025;83(9):s00451809332 . Address for correspondence Pedro Augusto Sampaio Rocha-Filho (email: pedro. rochaﬁ[lho@ufpe.br](lho@ufpe.br)) Abstract Keywords ► Headache ► Headache Disorders, Secondary ► Migraine Disorders ► Tension-Type Headache ► Therapeutics ► Analgesics ► Review Medication-overuse headache affects 1 to 2% of the global population and is often associated with chronic migraine. This condition signiﬁcantly impacts the lives of patients, as well as their families, and it poses a major economic burden due to lost productivity and medical costs. The present narrative review is part of a controversy session. We argue that reversing the behavior of overusing symptomatic pain medications is important for the treatment of this type of headache. To support this argument, the article reviews and critically analyzes the relevant literature on the subject. MEDICATION-OVERUSE HEADACHE To diagnose an individual with a medication-overuse headache (MOH), they must have experienced a prior headache, typically primary, whose characteristics change and/or worsen signiﬁcantly with the regular use of symptomatic pain medications, leading to a frequency of daily or almost daily headaches ( 􀀁 15 attacks/month).1–3 With a varied This article is part of a debate series on Headache and Pain (CGRPMonoclonal Antibodies for Migraine), featuring different perspectives. Check out the other points of view: [https://doi.org/10.1055/](https://doi.org/10.1055/)[ ](https://doi.org/10.1055/)s-0045-1809333 and [https://doi.org/10.1055/s-0045-1809658](https://doi.org/10.1055/s-0045-1809658). received February 11, 2025 received in its ﬁnal form February 26, 2025 accepted March 7, 2025 DOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1809332 . ISSN 0004-282X. Editor-in-Chief: Hélio A. G. Teive. Associate Editor: Carlos Henrique Ferreira Camargo. Guest Editor: Pedro Augusto Sampaio Rocha Filho. potential,2 pain medications that can cause MOH include opioids, triptans, ergotamine, nonsteroidal anti-inﬂammatory drugs (NSAIDs), and common analgesics. It is estimated that the prevalence of MOH in the general population is between 1% and 2%. 1,3 Despite being classiﬁed as secondary, the requirement of having a prior headache for its development raises the question of whether excessive use of medications is a risk factor for worsening of the primary condition. For instance, excessive use of symptomatic pain medications is known to worsen migraines.4 Most patients with medication-overuse headaches have chronic migraines, and vice versa. 1,3 © 2025 . The Author(s) . This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/)) Thieme Revinter Publicações Ltda. , Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil 2 CGRP MAbs and medication-overuse headache Rocha-Filho There is a consensus that prophylactic treatment for the primary headache should be initiated early as part of MOH treatment, emphasizing that addressing the primary condition is central to management of the secondary one. 5,6 Neuroimaging studies in this cohort reveal structural and functional alterations in the pain-processing areas of the central n

FAQs

How is medication-overuse headache diagnosed?

Medication-overuse headache is diagnosed when a prior headache typically changes and/or worsens with regular use of symptomatic pain medications, leading to daily or nearly daily headache frequency (about 15 or more attacks per month).

Which medication types are associated with medication-overuse headache?

Opioids, triptans, ergotamine, nonsteroidal anti-inflammatory drugs (NSAIDs), and common analgesics are identified as medications that can cause medication-overuse headache.

Why is stopping excessive pain medication considered necessary in this review?

Reversing medication overuse is described as essential because it improves headache frequency, intensity, and impact and can reduce anxiety and depressive symptoms; evidence also suggests success rates above 70%, though relapse remains possible.

Sep 29, 2026

Uploaded by Himbo