Chronic migraine patients often overuse acute medications, and this can lead to medication-overuse headaches. In individual patients, however, it is difficult to determine if medication overuse is the cause of or a response to frequent headaches. Barbiturate-containing analgesics or opioids are very high risk. Triptans and nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen are lower risk. Frequency of more than 10 days a month should be avoided. All patients do not revert from chronic migraine to episodic migraine after medication overuse is stopped. Fifty percent or more can be treated with only simple educational intervention over 18 months. About 40% of “detoxified” patients relapse within the first year after withdrawal.
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