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OBJECTIVE:Medication-overuse headache(MOH)in cluster headache(CH)patients is incompletely described,perhaps because of the relatively low prevalence of CH.METHODS:The authors describe a retrospective series of 17 patients(13 men,4 women)with CH who developed MOH in association with overuse of a wide range of monotherapies or varying combinations of simple analgesics(n = 9),caffeine(n = 1),opioids(n = 10),ergotamine(n = 3),and triptans(n = 14).The series includes both episodic(n = 7)and chronic(n = 10)CH patients.RESULTS:A specific triptan-overuse headache diagnosis was made in 3 patients,an opioid-overuse headache diagnosis was made in 1 patient,and an ergotamine-overuse headache diagnosis was made in 1 patient.In approximately half of the patients(n = 8),the MOH phenotype was a bilateral,dull,and featureless daily headache.In the other 9 patients,the MOH was characterized by at least one associated feature,most commonly nausea(n = 6),exacerbation with head movement(n = 5),or throbbing character of the pain(n = 5).The common denominator in 15 patients was a personal or family history,or both,of migraine.The 2 other patients gave a family history of unspecified headaches.Medication withdrawal was attempted and successful in 13 patients.CONCLUSIONS:Medication-overuse headache is a previously underrecognized and treatable problem associated with cluster headache(CH).CH patients should be carefully monitored,especially those with a personal or family history of migraine.
OBJECTIVE: Medication-overuse headache (MOH) in cluster headache (CH) patients is incompletely described, perhaps because of the relatively low prevalence of CH.METHODS: The authors describe a retrospective series of 17 patients (13 men, 4 women) with CH who developed MOH in association with overuse of a wide range of monotherapies or varying combinations of simple analgesics (n = 9), caffeine (n = 1), opioids (n = 10), ergotamine (n = 3), and triptans = 14). The series includes both episodic (n = 7) and chronic (n = 10) CH patients .RESULTS: A specific triptan-overuse headache diagnosis was made in 3 patients, an opioid-overuse headache diagnosis was made in 1 patient , and an ergotamine-overuse headache diagnosis was made in 1 patient. approximately half of the patients (n = 8), the MOH phenotype was a bilateral, dull, and featureless daily headache. in the other 9 patients, the MOH was characterized by at least one associated feature, most commonly nausea (n = 6), exacerbation with head movement (n = 5), or throbbing character of the pain (n = 5) .The common denominator in 15 patients was a personal or family history, or both, of migraine.The 2 other patients gave a family history of unspecified headaches. Medication withdrawal was attempted and successful in 13 patients .CONCLUSIONS: Medication-overuse headache is a previously underrecognized and treatable problem associated with cluster headache (CH) .CH patients should be carefully monitored, especially those with a personal or family history of migraine.