When should I consider referring a patient with MOH to a specialist for further management?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Consider referring a patient with medication overuse headache to a specialist if there is uncertainty about the diagnosis or atypical symptoms, such as motor weakness, double vision, visual symptoms affecting only one eye, poor balance, or decreased level of consciousness .

Refer if previous repeated drug withdrawal attempts have been unsuccessful .

Refer if the patient is overusing strong opioids, barbiturates, or tranquilizers, or has significant comorbidities needing specialist management .

Refer if there is suspicion of serious underlying causes, such as red flags or a serious secondary headache, or if there are red flags or a suspected serious underlying cause of headache .

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Educational content only. Always verify information and use clinical judgement.