Medication Overuse Headache Linked to Stress, Lifestyle Factors

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Patients with medication overuse headache (MOH) may benefit from stress reduction and healthy changes to their lifestyle, according to a new study from Denmark.

“High stress plus smoking, low physical activity, or obesity has synergistic effects in MOH. So, stress reduction is highly relevant in MOH management,” said Rigmor H. Jensen, MD, in Neurology Reviews. Dr. Jensen is a Professor of Neurology and Director of the Danish Headache Center at the University of Copenhagen; she presented the study in May at the International Headache Congress in Valencia, Spain.

MOH occurs when patients regularly rely on analgesics for pain relief. Over the long-term, the medications can cause headaches, and successful treatment requires discontinuing their use. However, Dr. Jensen and her colleagues determined that addressing a variety of lifestyle factors, such as weight loss, smoking cessation, and stress reduction, may also be beneficial when addressing these rebound headaches.

In a study of 129,150 Danish adults, more than 68,000 were classified as having MOH. Nearly 60% of those patients reported the highest stress levels, scoring within the top quintile of all study participants in that category. Researchers also determined that among those with the highest stress, smoking significantly increased the rates of developing MOH, as did being obese and being sedentary.

Dr. Jensen and colleagues also determined, after controlling for stress levels, that MOH was most likely among individuals with all five unhealthy behaviors analyzed in the study: daily smoking, excessive alcohol intake, physical inactivity, obesity, and illicit drug use. Among men, those factors were linked with 5.1-fold increase for the chance of having MOH and a nearly 3-fold increase among women.

Finally, researchers determined that even a modest reduction in stress levels improved MOH management.

NHF President Arthur Elkind, MD, noted the potential importance of this study, adding that the recommendation to explore how stress affects patients is often lacking. Evaluating stress, along with the other lifestyle components, may be beneficial.

“Patients with MOH are often frustrating to physicians as well as themselves due to lack of response,” he said. “Assessing stress in these individuals may lead to greater improvements.”