Medication Overuse or Refractory Headache

Many patients arrive on alot of pain meds/analgesics, with a letter in hand from some neurologist or headache center, stating they have “MOH: medication overuse headache”. These patients have frequent(often daily) moderate or severe headaches, and have not found that any daily preventive, or Botox, helps enough. So, instead of staying in bed, they take whatever helps them to function, whether it is Excedrin or Fiorinal(butalbital) or sumatriptan or hydrocodone or a combination. The truth from my vantage point is that only about 46% of people find daily preventives, over the long term, to be all that useful; the other 54% find that they either wear out, or they have intolerable side effects. There is MOH, and then there is simple MO: medication overuse(without headaches resulting from it). It can be very difficult to determine whether someone is actually suffering rebound(withdrawal) headache from the overuse of the meds, or simply recurrence of their daily headache, having little to do with the meds. What we do not want to do is punish or blame the poor suffering patient.