Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/78280
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Type: Journal article
Title: Medication-overuse headache and opioid-induced hyperalgesia: A review of mechanisms, a neuroimmune hypothesis and a novel approach to treatment
Author: Johnson, J.
Hutchinson, M.
Williams, D.
Rolan, P.
Citation: Cephalalgia, 2013; 33(1):52-64
Publisher: Blackwell Science Ltd
Issue Date: 2013
ISSN: 0333-1024
1468-2982
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Responsibility: 
Jacinta L Johnson, Mark R Hutchinson, Desmond B Williams and Paul Rolan
Abstract: 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 mechanism-based 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.
Keywords: Medication-overuse headache; opioid-induced hyperalgesia; codeine; glia; cytokines; ibudilast
Rights: © International Headache Society 2012
RMID: 0020123596
DOI: 10.1177/0333102412467512
Appears in Collections:Pharmacology publications

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