title: Medication overuse headache - An under-diagnosed problem in shunted idiopathic intracranial hypertension patients.
abstract: OBJECTIVE
  Management of headache in a subgroup of shunted idiopathic intracranial hypertension (IIH) patients is a well- described and difficult task. We present our series of shunted IIH patients with medication overuse headache (MOH) and discuss the role of careful pain management in this group of patients.
  
  
  METHODS
  A retrospective review of shunted IIH patients with headache, who had their shunt function assessed by monitoring their intracranial pressure and were subsequently diagnosed with MOH.
  
  
  RESULTS
  A total of 15 patients were identified. The mean time between the diagnosis of IIH and the diagnosis of medication overuse headache was 6 years (standard deviation 4.9, range 2-18 years). The majority of patients in this group (12/15) had undergone multiple shunt revisions.
  
  
  CONCLUSIONS
  Medication overuse headache in shunted IIH patients can lead to the requirement of hospital admission, investigations and procedures. We suggest that opiates and non-steroidal anti-inflammatory analgesics (NSAIDs) are used for a specified duration post-operatively and reviewed regularly. We suggest that patients are counselled regarding medication overuse headache in a multidisciplinary setting.
authors.affiliation: a Victor Horsley Department of Neurosurgery , National Hospital for Neurology and Neurosurgery , Queen Square, London , UK.
authors.forename: Ruth-Mary
authors.initials: RM
authors.lastname: deSouza
authors.affiliation: a Victor Horsley Department of Neurosurgery , National Hospital for Neurology and Neurosurgery , Queen Square, London , UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Toma
authors.affiliation: a Victor Horsley Department of Neurosurgery , National Hospital for Neurology and Neurosurgery , Queen Square, London , UK.
authors.forename: Laurence
authors.initials: L
authors.lastname: Watkins
keywords: headache; idiopathic intracranial hypertension; medication; overuse; shunt