title: Risk of development of medication overuse headache with nonsteroidal anti-inflammatory drug therapy for migraine: a critically appraised topic.
abstract: BACKGROUND
  The development of medication overuse headache (MOH) is associated with frequent use of analgesics, especially opiates, for treatment of primary headache disorders, particularly migraine. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat migraine.
  
  
  OBJECTIVE
  To critically evaluate evidence estimating the risk of MOH associated with NSAID therapy in patients with migraine.
  
  
  METHODS
  The objective was addressed through the development of a structured, critically appraised topic. This included a clinical scenario, structured question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom line conclusions. Participants included consultant and resident neurologists, a medical librarian, clinical epidemiologists, and headache neurology content experts.
  
  
  RESULTS
  The 1-year incidence of MOH was 2.5%. In patients with low (0 to 4 d monthly) to moderate (5 to 9 d monthly) baseline headache frequency, NSAIDs were not associated with progression to MOH and may be protective (odds ratio=0.31; 95% confidence interval, 0.27-0.34). However, in patients with a high baseline headache frequency (10 to 14 d monthly), NSAIDs are associated with progression to MOH (odds ratio=1.93; 95% confidence interval, 1.82-2.06).
  
  
  CONCLUSIONS
  Acute NSAID therapy is associated with progression to MOH in migraineurs with a high baseline migraine frequency but may be protective in patients with low baseline headache frequency. However, a causal role for NSAIDs in progression from episodic to chronic headache has not been established.
authors: Department of Neurology and Library Services, Mayo Clinic, Scottsdale, AZ 85255, USA.
authors: Amaal J
authors: AJ
authors: Starling
authors: Charlene
authors: C
authors: Hoffman-Snyder
authors: Rashmi B
authors: RB
authors: Halker
authors: Kay E
authors: KE
authors: Wellik
authors: Bert B
authors: BB
authors: Vargas
authors: David W
authors: DW
authors: Dodick
authors: Bart M
authors: BM
authors: Demaerschalk
authors: Dean M
authors: DM
authors: Wingerchuk
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D020773:Headache Disorders / Q000139:chemically induced*; D006305:Health Status Indicators; D006801:Humans; D008137:Longitudinal Studies; D008881:Migraine Disorders / Q000188:drug therapy*; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal