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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.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/calcitonin-gene-related-peptide-monoclonal-antibodies-and-medication-overuse-headache-stopping-excessive-pain-medication-is-still-necessary/435866/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/calcitonin-gene-related-peptide-monoclonal-antibodies-and-medication-overuse-headache-stopping-excessive-pain-medication-is-still-necessary/435866.png","ImageObject",300,407,{"name":92,"@type":93},"Himbo","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How is medication-overuse headache diagnosed?","Question",{"text":112,"@type":113},"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).","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Which medication types are associated with medication-overuse headache?",{"text":117,"@type":113},"Opioids, triptans, ergotamine, nonsteroidal anti-inflammatory drugs (NSAIDs), and common analgesics are identified as medications that can cause medication-overuse headache.",{"name":119,"@type":110,"acceptedAnswer":120},"Why is stopping excessive pain medication considered necessary in this review?",{"text":121,"@type":113},"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.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},435866,1790766047,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},687197100911,"https://ap-avatar.wpscdn.com/avatar/a000239b6f1da00475?x-image-process=image/resize,m_fixed,w_180,h_180&k=1785132997149421697","Article published online: 2025-07-28  \nPoint of View 1  \nCalcitonin gene-related peptide monoclonal antibodies and medication-overuse headache: stopping excessive pain medication is still necessary  \nPedro Augusto Sampaio Rocha-Filho 1,2  \n1 Universidade Federal de Pernambuco, Centro de Ciências Médicas,Área Acadêmica de Neuropsiquiatria, Recife PE, Brazil.  \n2 Universidade de Pernambuco, Hospital Universitário Oswaldo Cruz, Serviço de Neurologia, Recife PE, Brazil.  \nArq. Neuro-Psiquiatr. 2025;83(9):s00451809332 .  \nAddress for correspondence Pedro Augusto Sampaio Rocha-Filho (email: pedro. rochafi[lho@ufpe.br](lho@ufpe.br))  \nAbstract  \nKeywords  \n► Headache  \n► Headache Disorders, Secondary  \n► Migraine Disorders  \n► Tension-Type Headache  \n► Therapeutics  \n► Analgesics  \n► Review  \nMedication-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.  \nMEDICATION-OVERUSE HEADACHE  \nTo 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  \nThis 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).  \nreceived  \nFebruary 11, 2025 received in its final form February 26, 2025 accepted  \nMarch 7, 2025  \nDOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1809332 . ISSN 0004-282X.  \nEditor-in-Chief: Hélio A. G. Teive.  \nAssociate Editor: Carlos Henrique Ferreira Camargo.  \nGuest Editor: Pedro Augusto Sampaio Rocha Filho.   \npotential,2 pain medications that can cause MOH include opioids, triptans, ergotamine, nonsteroidal anti-inflammatory drugs (NSAIDs), and common analgesics.  \nIt 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  \n© 2025 . The Author(s) .  \nThis 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/))  \nThieme Revinter Publicações Ltda. , Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil  \n2 CGRP MAbs and medication-overuse headache Rocha-Filho  \nThere 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  \nNeuroimaging studies in this cohort reveal structural and functional alterations in the pain-processing areas of the central n","cbCaimXtXXFkfOmt","https://ap.wps.com/l/cbCaimXtXXFkfOmt","pdf",242979,"English","# Medication-overuse headache\n## Diagnosis and epidemiology\n## Pathophysiology and neuroimaging findings\n## Clinical heterogeneity\n## Reversal strategies and outcomes\n## Relapse considerations","[{\"question\":\"How is medication-overuse headache diagnosed?\",\"answer\":\"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).\"},{\"question\":\"Which medication types are associated with medication-overuse headache?\",\"answer\":\"Opioids, triptans, ergotamine, nonsteroidal anti-inflammatory drugs (NSAIDs), and common analgesics are identified as medications that can cause medication-overuse headache.\"},{\"question\":\"Why is stopping excessive pain medication considered necessary in this review?\",\"answer\":\"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.\"}]","Calcitonin gene-related peptide monoclonal antibodies and medication-overuse headache - stopping excessive pain medication is still necessary | PDF",1790675660]