{ "schemaVersion": 2, "eyebrow": "Headache Medicine", "title": "Medication-Overuse Headache", "summary": "Medication-overuse headache requires recognition of class-specific acute-medication thresholds, exclusion of alternative secondary headache causes, and a planned withdrawal strategy. Most patients stop nonopioid acute agents abruptly while migraine prevention and close follow-up address withdrawal symptoms, persistent migraine, and relapse risk.", "seoDescription": "Physician guide to diagnosing and managing medication-overuse headache, including medication thresholds, withdrawal strategy, prevention, and follow-up.", "clinicalQuestion": "How should clinicians identify and treat medication-overuse headache while managing withdrawal and the underlying primary headache disorder?", "specialty": "Neurology", "audience": "U.S. physicians and medical trainees", "tags": [ "medication-overuse headache", "rebound headache", "chronic migraine", "acute medication overuse", "headache withdrawal" ], "keyTakeaways": [ "Diagnose medication-overuse headache when headache occurs on more than 15 days per month with overuse for more than 3 months: at least 10 days monthly for triptans, opioids, ergots, or combination analgesics, or at least 15 days monthly for simple analgesics or NSAIDs. [20][22]", "Withdrawal of the overused acute medication is the central intervention; abrupt cessation is generally preferred for analgesics and triptans, whereas opioids should be tapered and warrant assessment for dependence-related complications. [2][22]", "Start or optimize preventive therapy for the antecedent headache disorder during withdrawal or after its re-emergence; for chronic migraine, supported preventive options include topiramate, onabotulinumtoxinA, and CGRP monoclonal antibodies. [2]", "Warn patients that headache commonly worsens before recovery after stopping acute medication, then reassess attack frequency, severity, disability, and acute-medication days within 2 to 3 months. [2][13]" ], "sections": [ { "id": "diagnostic-thresholds", "eyebrow": "Diagnosis", "heading": "Confirm the medication-use pattern before attributing chronic headache to overuse", "intro": "A medication diary is the highest-yield first test.", "paragraphs": [ "Obtain a prospective 30-day headache and medication diary that records headache days, acute-medication days by class, dose, and use of combination products. Diagnose medication-overuse headache when headache is present on more than 15 days per month, acute headache medication has been overused for more than 3 months, and headache developed or worsened during that exposure pattern. Patients with both chronic migraine and medication-overuse headache should retain both diagnoses because withdrawal does not replace treatment of the underlying migraine disorder. [19][22]", "Classify overuse by medication days rather than total pills. The operational threshold is at least 10 days per month for triptans, ergotamine, opioids, and combination analgesics; combination products include agents such as Excedrin, barbiturate-containing products, and Midrin. The threshold is at least 15 days per month for aspirin, acetaminophen, ibuprofen, naproxen sodium, or other prescription NSAIDs used alone. Apply the multiple-class overuse category when aggregate acute-medication exposure meets overuse criteria although no single class does. [20][22]", "Do not diagnose medication-overuse headache solely because the patient has frequent medication exposure. The association between acute-medication use and frequent headache is complicated by confounding from the underlying headache burden; use the diary together with temporal worsening during overuse and response after withdrawal to reassess the diagnosis. [21]" ], "bullets": [ "Ask specifically about OTC acetaminophen, aspirin, ibuprofen, naproxen, caffeine-containing combination products, barbiturate-containing products, opioids, triptans, and ergotamine; patients may not identify OTC combination products as headache medication. [20]", "Document the antecedent headache phenotype and current headache-day burden before withdrawal so that residual migraine or another primary headache disorder can be treated after detoxification. [2][19]" ], "subsections": [], "table": { "caption": "Medication-day thresholds used to identify acute medication overuse. [20][22]", "columns": [ "Acute medication class", "Overuse threshold", "Clinical implication" ], "rows": [ [ "Triptans, ergotamine, opioids", "At least 10 days per month for more than 3 months [20][22]", "Meets class-specific overuse threshold in a patient with headache on more than 15 days monthly. [22]" ], [ "Combination analgesics, including caffeine- or barbiturate-containing products", "At least 10 days per month for more than 3 months [20][22]", "Assign combination-analgesic-overuse headache when diagnostic criteria are met. [9]" ], [ "Acetaminophen, aspirin, NSAIDs used alone", "At least 15 days per month for more than 3 months [20][22]", "Meets simple-analgesic overuse threshold in a patient with headache on more than 15 days monthly. [22]" ], [ "Multiple acute-medication classes", "Aggregate use may meet criteria when no single class reaches its individual threshold. [20]", "Identify all contributing agents before constructing the withdrawal plan. [20]" ] ] } }, { "id": "triage-and-workup", "eyebrow": "Initial Assessment", "heading": "Separate likely medication overuse from urgent secondary headache", "intro": "Medication overuse should not terminate the secondary-headache assessment.", "paragraphs": [ "At the initial visit, compare the current headache with the patient's established phenotype and determine whether the frequency increase tracks acute-medication escalation. A stable migraine-like phenotype with qualifying medication exposure supports medication-overuse headache; a distinctly new phenotype, progressive focal neurologic symptoms, altered consciousness, systemic illness, or abrupt severe onset requires evaluation for an alternative secondary cause before assuming medication overuse.", "Prioritize opioid exposure as a separate management branch. Opioids can contribute to medication-overuse headache and opioid-induced hyperalgesia, and abrupt discontinuation is not the default strategy for opioid overuse. Establish the prescribed and nonprescribed opioid regimen, duration of use, prior withdrawal symptoms, and concurrent sedative exposure, then select a tapering plan rather than an unsupervised abrupt stop. [4][2][22]", "Refer chronic migraine with medication overuse to headache-specialist care when withdrawal fails, diagnostic uncertainty persists, opioid or other addictive-drug use complicates management, or preventive treatment selection requires escalation. Chronic migraine itself is a specialist-referral indication in the ten-step migraine management framework. [2]" ], "bullets": [ "Use the diary to identify whether morning or persistent daily headache coincides with medication escalation; medication-overuse headache is often persistent and may be worst on awakening. [22]", "Reassess the diagnosis after withdrawal if headache frequency does not improve or the post-withdrawal phenotype is discordant with the presumed underlying disorder. [2][21]" ], "subsections": [], "table": { "caption": "Management branches determined by the overused medication class. [2][4][22]", "columns": [ "Clinical branch", "Key discriminator", "Next action" ], "rows": [ [ "Simple analgesic, NSAID, triptan, or combination-analgesic overuse", "Qualifying medication-day threshold without opioid dependence concerns [20][22]", "Explain expected transient worsening and plan abrupt withdrawal. [2][22]" ], [ "Opioid overuse", "Current opioid exposure, possible dependence, or concern for opioid-induced hyperalgesia [4]", "Plan gradual taper rather than routine abrupt withdrawal; involve appropriate addiction or pain-management support when needed. [2][22]" ], [ "Persistent chronic migraine after overuse is addressed", "Headache remains frequent after medication withdrawal and reassessment [2]", "Initiate or optimize migraine prevention with an evidence-based chronic migraine option. [2]" ], [ "Atypical or changing headache syndrome", "Current symptoms differ materially from the prior primary-headache phenotype", "Evaluate for another secondary headache disorder before attributing the presentation to medication overuse." ] ] } }, { "id": "withdrawal-plan", "eyebrow": "Detoxification", "heading": "Use an explicit withdrawal plan rather than a vague reduction target", "intro": "Education and a defined stop date improve implementation.", "paragraphs": [ "Explain that medication withdrawal is the necessary core treatment and that headache usually worsens before recovery. For overused analgesics and triptans, use abrupt discontinuation rather than gradual dose reduction. This can usually be managed in primary care when addictive drugs are not involved; opioid exposure is the major exception and should be tapered. [2][22]", "Set the withdrawal plan in writing: identify every acute agent to stop, establish the cessation date, review anticipated headache worsening and associated symptoms, and specify how the patient will contact the practice if withdrawal becomes unmanageable. Detoxification commonly produces predictable withdrawal symptoms, and successful detoxification is associated with improved headache outcomes and fewer monthly headache days by 8 weeks. [13]", "Avoid allowing a bridge plan to become replacement overuse. Bridging therapies have been used to reduce withdrawal-headache intensity and associated symptoms, but novel acute agents including ditans and gepants require further study in this setting. If prednisone is selected for withdrawal symptoms, one cited primary-care guide lists prednisone 60 mg as possibly effective; the same guide lists amitriptyline up to 50 mg as possibly effective for withdrawal symptoms. [13][22]" ], "bullets": [ "For analgesic or triptan overuse: stop the overused agent abruptly and prepare the patient for short-term worsening. [2][22]", "For opioid overuse: taper rather than abruptly discontinue; assess for opioid-related hyperalgesia and withdrawal risk. [4][2][22]", "Schedule active follow-up rather than waiting for the next routine visit, because early withdrawal symptoms can undermine adherence. [13]" ], "subsections": [ { "heading": "Preventive therapy during withdrawal", "paragraphs": [ "Preventive treatment for the antecedent migraine disorder can begin in parallel with acute-medication withdrawal or be initiated when the underlying headache disorder re-emerges; this timing remains debated. For chronic migraine once medication overuse has been addressed or excluded, evidence-based preventive options include topiramate, onabotulinumtoxinA, and CGRP monoclonal antibodies. [2]", "When topiramate is chosen in medication-overuse headache, a cited primary-care guide identifies a maximum daily dose of 200 mg. Select the preventive agent according to the underlying migraine phenotype, prior response, comorbidities, adverse-effect risk, access, and patient preference rather than using detoxification as the sole treatment. [22][2]" ], "bullets": [] } ], "table": { "caption": "Practical withdrawal sequence for medication-overuse headache. [2][13][22]", "columns": [ "Time point", "Required action", "Decision checkpoint" ], "rows": [ [ "Before withdrawal", "Quantify medication days by class and identify the underlying headache disorder with a diary. [20][22]", "Determine whether opioid exposure requires tapering rather than abrupt cessation. [2][22]" ], [ "Withdrawal start", "Abruptly stop overused analgesics or triptans; start a tapering strategy for opioids. [2][22]", "Counsel that headache may worsen before recovery. [2][13]" ], [ "During withdrawal", "Start or optimize preventive treatment for the antecedent headache disorder when clinically appropriate. [2]", "Do not substitute a new frequently used acute agent without tracking medication days." ], [ "About 8 weeks", "Review headache days and acute-medication days after detoxification. [13]", "If headache remains frequent, reassess diagnosis and optimize preventive therapy. [2]" ] ] } }, { "id": "longitudinal-management", "eyebrow": "Follow-up", "heading": "Measure response by headache burden and medication days", "intro": "Withdrawal success does not eliminate the need for migraine management.", "paragraphs": [ "At follow-up, review the same diary fields used at baseline: monthly headache days, monthly acute-medication days by class, attack severity, and migraine-related disability. Evaluate response shortly after initiating or changing therapy, at 2 to 3 months, then every 6 to 12 months once the regimen is stable. [2]", "If outcomes remain suboptimal, first review whether medication overuse has recurred, whether the post-withdrawal phenotype still supports migraine, and whether the preventive strategy is being used and tolerated. A patient whose medication use no longer meets overuse thresholds but who continues to have frequent migraine needs escalation of migraine prevention rather than repeated detoxification alone. [2][20]", "Prevent recurrence by discussing class-specific medication-day limits before prescribing or refilling acute treatment. Frequent acute-medication use is a modifiable risk factor for headache-frequency progression, and patients with migraine should be educated about medication-overuse risk before use becomes established. [2][21]" ], "bullets": [ "At 2 to 3 months: compare attack frequency, severity, disability, and acute-medication days with baseline. [2]", "Every 6 to 12 months after stabilization: reassess efficacy, adverse effects, adherence, and return of overuse. [2]", "At every acute-medication refill: reconcile OTC and prescription headache agents against the 10-day and 15-day monthly thresholds. [20][22]" ], "subsections": [], "table": { "caption": "Follow-up metrics that determine the next management step. [2][20][22]", "columns": [ "Metric", "Interpretation", "Next step" ], "rows": [ [ "Acute-medication days by class", "At least 10 days monthly for triptans, opioids, ergots, or combination analgesics, or at least 15 days monthly for simple analgesics, suggests recurrent overuse. [20][22]", "Reinstitute a medication-withdrawal plan and reassess the preventive regimen. [2]" ], [ "Headache frequency after withdrawal", "Persistent frequent headaches may reflect inadequately treated chronic migraine or an alternative diagnosis. [2][21]", "Reassess phenotype and optimize chronic migraine prevention. [2]" ], [ "Attack severity and disability", "Persistent burden despite reduced acute-medication use indicates incomplete control of the underlying headache disorder. [2]", "Adjust preventive treatment and assess adherence and tolerability. [2]" ], [ "Opioid use", "Continued opioid exposure may sustain medication-overuse headache or opioid-induced hyperalgesia. [4]", "Continue an individualized tapering and multidisciplinary management plan. 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Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Comparison of 3 Treatment Strategies for Medication ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamaneurology/fullarticle/2766518", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by LN Carlsen · 2020 · Cited by 148 — This randomized clinical trial compares 3 treatment strategies among patients with medication overuse headache in Denmark.", "score": 0.37202653 }, { "number": 2, "title": "Diagnosis and management of migraine in ten steps", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41582-021-00509-5", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Withdrawal of the overused medication is the necessary and only remedy for MOH107.\"). Expert consensus is that abrupt withdrawal is preferable to slow withdrawal, except for opioids30.\"). This process can be managed in primary care unless addictive drugs, such as opioids, are involved108.\"),109.\"). ", "score": 0.6455898 }, { "number": 3, "title": "Migraine | Nature Reviews Disease Primers", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41572-021-00328-4", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "PubMed \n PubMed Central \n Google Scholar\n242. Carlsen, L. N. et al. Comparison of 3 treatment strategies for medication overuse headache: a randomized clinical trial. JAMA Neurol. 77, 1069–1078 (2020).\n\n PubMed \n Google Scholar\n243. Evers, S. & Jensen, R. Treatment of medication over", "score": 0.44478238 }, { "number": 4, "title": "PACAP-PAC1 receptor inhibition is effective in opioid ...", "detail": "www.cell.com", "url": "https://www.cell.com/iscience/fulltext/S2589-0042(23)00027-5", "authors": "www.cell.com", "host": "www.cell.com", "snippet": "by Z Bertels · 2023 · Cited by 11 — Summary Opioids prescribed for pain and migraine can produce opioid-induced hyperalgesia (OIH) or medication overuse headache (MOH).", "score": 0.23927864 }, { "number": 5, "title": "The Many Faces of Medication‐Overuse Headache in Clinical ...", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.13785", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com", "snippet": "Third Edition (ICHD-3), medication-overuse headache (MOH) is a separate diagnostic entity within the group of secondary headache disorders.10", "score": 0.7463059 }, { "number": 6, "title": "Treatment of medication overuse headache – guideline ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/j.1468-1331.2011.03497.x", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "This guideline aims to give recommendations for the treatment of medication overuse headache (MOH) as classified by the International Headache", "score": 0.657561 }, { "number": 7, "title": "American Headache Society 66th Annual Scientific Meeting ...", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.14771", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com", "snippet": "The pathophysiology of headache disorders such as medication overuse headache (MOH) is poorly understood, making treatment difficult. ICHD-3 ,", "score": 0.6391287 }, { "number": 8, "title": "overuse headache", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/ene.14268", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "by HC Diener · 2020 · Cited by 167 — Treatment of medication overuse headache – guideline of the EFNS headache panel. ... Clinical features of withdrawal headache following overuse", "score": 0.63777614 }, { "number": 9, "title": "European Academy of Neurology guideline on the ...", "detail": "onlinelibrary.wiley.com", "url": "https://onlinelibrary.wiley.com/doi/10.1111/ene.14268", "authors": "onlinelibrary.wiley.com", "host": "onlinelibrary.wiley.com", "snippet": "Patients who overuse combination-analgesic medications should receive the diagnosis 'combination-analgesic-overuse headache' (ICHD 8.2.5).", "score": 0.59061456 }, { "number": 10, "title": "Evidence Regarding Medication Overuse Headache in ...", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.13726", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com", "snippet": "This proposed systematic review will identify the existing evidence on medication-overuse headache in children and adolescents.", "score": 0.5104727 }, { "number": 11, "title": "American Headache Society 67th Annual Scientific Meeting ...", "detail": "headachejournal.onlinelibrary.wiley.com", "url": "https://headachejournal.onlinelibrary.wiley.com/doi/10.1111/head.14957", "authors": "headachejournal.onlinelibrary.wiley.com", "host": "headachejournal.onlinelibrary.wiley.com", "snippet": "International Classification of Headache Disorders (ICHD-3). for medication management and refills. Some Veterans reported that they received", "score": 0.42677602 }, { "number": 12, "title": "Medication Overuse - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/medication-overuse", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "One approach is to taper the overused medication gradually while an effective preventive therapy is established. The second strategy is to abruptly", "score": 0.7443038 }, { "number": 13, "title": "Medication-overuse headache: Bridging therapies for detoxification", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0303846725004883", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Medication-overuse headache (MOH) or rebound headache is caused by frequent use of acute pain medications and often complicates chronic migraine. The exact cause for this association remains unknown but is likely to represent complex interplay between psychosocial factors, class of medication overus", "score": 0.638588 }, { "number": 14, "title": "Cluster Headache - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/medicine-and-dentistry/cluster-headache", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "occurring if more than two courses are administered per year.120 The author and colleagues start patients on oral prednisolone (prednisone), 1 mg/kg, increasing the dosage to a maximum of 60 mg every day for 5 days, and thereafter decreasing the dosage by 10 mg every 3 days. Unfortunately, relapse a", "score": 0.38831696 }, { "number": 15, "title": "Drug Detoxification - an overview", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/topics/immunology-and-microbiology/drug-detoxification", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Familiarity and comfort with drug withdrawal and detoxification strategies are essential for the treatment of patients with medication overuse headache (Table", "score": 0.38380352 }, { "number": 16, "title": "SPINEPASS Randomized Clinical Trial Protocol | Physical ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/ptj/article/106/1/pzaf143/8362131", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by J Treleaven · 2026 — Many patients do not respond well to pharmacological interventions and this frequently leads to medication-overuse headaches that add to disability and further", "score": 0.5412882 }, { "number": 17, "title": "Primary Care Management of Headache - Oxford Academic", "detail": "academic.oup.com", "url": "https://academic.oup.com/milmed/article/187/9-10/e1091/6504461", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by JJ Sico · 2022 · Cited by 6 — This synopsis summarizes the key features of the guideline in three areas: prevention, assessing and treating medication overuse headache, and", "score": 0.35689533 }, { "number": 18, "title": "Pilot Study of Amitriptyline in the Prophylactic Treatment of ...", "detail": "academic.oup.com", "url": "https://academic.oup.com/painmedicine/article-pdf/15/10/1803/11009524/15-10-1803.pdf", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by W Fan · 2014 · Cited by 16 — This study aims to evaluate the long- term efficacy of low-dose amitriptyline combined with abrupt withdrawal in outpatients of medication- overuse headache (", "score": 0.2751034 }, { "number": 19, "title": "Eptinezumab With Patient Education for Chronic Migraine and Medication-Overuse Headache", "detail": "www.neurology.org", "url": "https://www.neurology.org/doi/10.1212/WNL.0000000000214863", "authors": "www.neurology.org", "host": "www.neurology.org", "snippet": "6.\n\nDiener HC, Antonaci F, Braschinsky M, et al. European Academy of Neurology guideline on the management of medication-overuse headache. _Eur J Neurol_. 2020;27(7):1102-1116.\n\nCrossref\n\nPubMed\n\nGoogle Scholar\n\n [a [...] (CM) and MOH are given both diagnoses.](\n [b [...] ineffective, adding pre", "score": 0.70580584 }, { "number": 20, "title": "Medication Overuse and Headache Burden", "detail": "www.neurology.org", "url": "https://www.neurology.org/doi/10.1212/CPJ.0000000000001037", "authors": "www.neurology.org", "host": "www.neurology.org", "snippet": "To establish an operational definition for overuse by acute medication class, we chose medication use days per month criteria consistent with medication use rates in ICHD-3 criteria for MOH; AMO was identified from ICHD-3 criteria for single medication class and multiple medication class overuse. Th", "score": 0.6455898 }, { "number": 21, "title": "Medication overuse headache", "detail": "www.neurology.org", "url": "https://www.neurology.org/doi/10.1212/WNL.0000000000004371", "authors": "www.neurology.org", "host": "www.neurology.org", "snippet": "## Get full access to this article\n\nView all available purchase options and get full access to this article.\n\nGet Access\n\nAlready a Subscriber? Sign in as an individual or via your institution\n\n## Supplementary Material\n\nFile(1206.pdf)\n\n Download\n 123.21 KB\n\nFile(appendix_e-1.pdf)\n\n Download\n ", "score": 0.54681134 }, { "number": 22, "title": "PHC ENG GUIDE 200 - Extranet Systems", "detail": "extranet.who.int", "url": "https://extranet.who.int/ncdccs/Data/LBN_D1_Final%20EN%20PHC%20Guide%20(September%2025,%202015).pdf", "authors": "extranet.who.int", "host": "extranet.who.int", "snippet": "PROPHYLACTIC TREATMENT 1. Verapamil 240-480 mg/ day in 3-4 divided doses, extended release dosage are less effective than divided doses.\n2. Do EKG before starting verapamil and with each dosage increase to monitor for prolonged PR interval and cardiac arrhythmia. 3. Refer if headache is not responsi", "score": 0.784336 }, { "number": 23, "title": "Why Should We Prescribe Medications to Treat Alcohol ...", "detail": "www.aasld.org", "url": "https://www.aasld.org/liver-fellow-network/core-series/why-series/why-should-we-prescribe-medications-treat-alcohol-use", "authors": "www.aasld.org", "host": "www.aasld.org", "snippet": "Patients starting medications for alcohol use disorder and abruptly decreasing their use of alcohol can experience alcohol withdrawal syndrome (AWS). Withdrawal symptoms typically develop in the 6-12 hours after cessation of alcohol; mild symptoms include anxiety, irritability, nausea, headache, tac", "score": 0.23074678 }, { "number": 24, "title": "Electronic Signature Page", "detail": "cdn.clinicaltrials.gov", "url": "https://cdn.clinicaltrials.gov/large-docs/39/NCT05452239/Prot_000.pdf", "authors": "cdn.clinicaltrials.gov", "host": "cdn.clinicaltrials.gov", "snippet": "4. Kristoffersen ES, Lundqvist C. Medication-overuse headache: epidemiology, diagnosis and treatment. Ther Adv Druf Saf. 2014;5(2):87-99.\n5. Westergaard ML, Munksgaard SB, Bendtsen L, Jensen RH. Medication-overuse headache: a perspective review. Ther Adv Drug Saf. 2016;7(4):147-158.\n6. Alstadhaug KB", "score": 0.6688159 } ], "publishedAt": "2026-08-24T16:34:07.347206+00:00", "updatedAt": "2026-08-24T16:34:07.347206+00:00", "readingMinutes": 5, "slug": "medication-overuse-headache" }