A woman in whom "pain-reliever" became "pain-giver"
1. 35-year old woman, known case of #migraine for 12 years, presented with increased frequency & severity of headaches for past 6 months (#headache occurred every single day in the past 3 months).
#MedTwitter #neurotwitter
1. 35-year old woman, known case of #migraine for 12 years, presented with increased frequency & severity of headaches for past 6 months (#headache occurred every single day in the past 3 months).
#MedTwitter #neurotwitter
2. Headache started early in the morning on awakening, after which she would take pain-relievers (sumatriptan, naproxen or ergotamine), which would relieve her headache for 4-6 hours, only to return by early evening. She would consume 30-40 tablets of pain-relievers every month.
3. She had disturbed sleep and also had features of #anxiety and #depression.
Headache, taking "pain-reliever" tablets, short duration pain relief followed by rebound headaches after 4-6 hours, occurring on daily basis had become a vicious cycle for her.
Headache, taking "pain-reliever" tablets, short duration pain relief followed by rebound headaches after 4-6 hours, occurring on daily basis had become a vicious cycle for her.
4. She was extremely disturbed and was unable to properly carry out household chores. She had quit her job for the past three months. Her life appeared worthless and she had #suicidal thoughts at times. It is in these desperate times, her husband brought her for my consultation.
5. After careful analysis of history, I made a diagnosis of medication overuse headache (MOH). MOH is caused when a patient with migraine or tension-type headache consumes more than 15 tablets of pain-relievers per month. Patients usually have >15 headache days/month for 3 months
6. I advised her to reduce the number of pain-reliever tablets (to not more than 2 per week).
I also started her on preventive migraine medications (which reduce the severity and frequency of headaches).
She followed psychiatrist's advice for anxiety and depression.
I also started her on preventive migraine medications (which reduce the severity and frequency of headaches).
She followed psychiatrist's advice for anxiety and depression.
7. I counselled her that she may face more headaches in short term however, would feel better after a few weeks.
At 6 week follow up, headache frequency had reduced to 10/month (from earlier 30/month). Another 6 weeks later, she only had two headache days/month.
At 6 week follow up, headache frequency had reduced to 10/month (from earlier 30/month). Another 6 weeks later, she only had two headache days/month.
8. She remained well (with only occasional headaches) for the next three months. Her mood symptoms and sleep quality also improved.
She rejoined work and was able to properly participate in household chores.
She rejoined work and was able to properly participate in household chores.
9. Take home message
*In patients with migraine, excessive intake of pain-relievers can cause medication overuse headache.
*Proper counselling, reducing/stopping of pain-killers and starting preventing medicines would help reduce headache frequency in patients with MOH.
*In patients with migraine, excessive intake of pain-relievers can cause medication overuse headache.
*Proper counselling, reducing/stopping of pain-killers and starting preventing medicines would help reduce headache frequency in patients with MOH.
• • •
Missing some Tweet in this thread? You can try to
force a refresh
