Do you know what MOH is? It stands for Medication Overuse Headache.
I was diagnosed with MOH in 2017 and I am still working on treating it.
What is MOH?
MOH is a chronic headache resulting from using acute medications more than 2-3 days per week. This includes things like triptans, non-steroidal anti-inflammatory drugs (NSAIDs), and other painkillers.
How is MOH treated?
MOH is difficult to treat not only because you have to stop taking the acute medication that caused it, but it can also make other acute medications less effective.
That being said, there are a series of strategies to treat MOH including preventative medications, infusions (migraine cocktail, DHE, lidocaine, or ketamine), neuromodulation devices, nerve blocks, and/or Botox, biofeedback, and targeted physical therapy.
I also want to add that the newest acute medications, the GEPANTS (Ubrelvy and Nurtec ODT) show no evidence of causing MOH!
My Experience with MOH
When I was diagnosed with MOH, I was shocked. I didn’t know there was such a thing as taking too many painkillers.
At the time, I was in college and my episodic migraine has just snowballed into chronic daily migraine and I was struggling to keep up with my studies. I had a stockpile of several different acute medications and I started taking something every day for a period of six months.
Fast forward 12 months, I had become severely disabled. I had to drop out of college and was bedbound with crippling daily pain. Soon after I was told that I have chronic intractable migraine, New Daily Persistent Headache (NDPH), and MOH. I was so angry with myself over the MOH diagnosis, but I shouldn’t have been because I was never educated on MOH or how to avoid it.
I visited a handful of headache specialists before finally finding one at the Mayo Clinic who was serious about helping me. He immediately admitted me to the hospital for back-to-back ketamine and lidocaine infusions. Unfortunately, I left with the same level of pain.
A year later, Botox, IV DHE, steroids, and a series of other preventatives had failed so I went back for a three-day outpatient IV administration of a ‘migraine cocktail’ (Toradol, Magnesium, Saline, Ativan, Zofran, Benadryl, Compazine). This migraine cocktail is the ONLY treatment that has even been able to touch my pain. I have gone back to the Mayo Clinic three times for this very same protocol.
Soon after I was able to start on Aimovig, the first CGRP mAb injection to hit the market. I also started using neuromodulation (e.g., gammaCore, Cefaly, Nerivio, Relivion) as a daily preventative and acute treatment, which lessened my reliance on medication. With monthly rounds of Aimovig, nerve blocks every three months, neuromodulation, and the occasional trip to the clinic for the IV migraine cocktail, my pain started to (very very slowly) decrease. Eventually, I was able to return to a university that was close to home and finish my undergraduate degree.
Please share your MOH story so we can educate people about MOH.
If you are struggling with MOH, know you are not alone and that there is hope.
Resources:
Scholarly Articles
https://pubmed.ncbi.nlm.nih.gov/32251023/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627250/
https://academic.oup.com/brain/article-abstract/143/9/2681/5894039
Life With Migraine 