How can I effectively counsel patients on the risks of medication overuse and the importance of reducing their analgesic intake?

Effectively counseling patients on medication overuse and reducing analgesic intake involves clear communication about the diagnosis, risks, and management plan.

• Explain the diagnosis: Inform patients that medication overuse headache (MOH) can worsen their existing headache disorder, such as migraine or tension-type headache, and that overuse of acute headache medications is the cause ¹.
• Discuss risks: Emphasize that frequent use of analgesics or specific drugs like triptans, ergotamines, and opioids can lead to chronic headache and medication overuse headache ¹,².
• Advise on withdrawal: Counsel patients to stop all overused acute headache medications abruptly for at least one month, as early withdrawal is the main treatment ¹,².
• Prepare for withdrawal symptoms: Warn that headaches may initially worsen and withdrawal symptoms such as nausea, sleep disturbance, anxiety, and restlessness may occur for 1–2 weeks, but improvement usually follows within weeks to months ¹.
• Use a headache diary: Encourage patients to keep a headache diary to track headache frequency, severity, and medication use during withdrawal to monitor progress ¹.
• Provide ongoing support: Arrange regular follow-up to review symptoms, provide encouragement, and reassess the underlying headache disorder 4–8 weeks after withdrawal starts ¹,².
• Prevent relapse: Advise limiting future use of acute headache medication to no more than 2 days per week to reduce the risk of recurrence ¹.
• Offer information and support resources: Provide patient leaflets and direct patients to support organizations such as Lifting the Burden, The Migraine Trust, and the British Association for the Study of Headache ¹.
• Address comorbidities: Assess and manage associated conditions like anxiety, depression, and chronic pain, which may contribute to medication overuse ¹.