Choosing Wisely:

Don’t recommend prolonged or frequent use of over-the-counter (OTC) pain medications for headache.

Rationale and Comments: OTC medications are appropriate treatment for occasional headaches if they work reliably without intolerable side effects. Frequent use (especially of caffeine-containing medications) can lead to an increase in headaches, known as medication overuse headache (MOH). To avoid this, OTC medication should be limited to no more than two days per week. In addition to MOH, prolonged overuse of acetaminophen can cause liver damage, while overuse of nonsteroidal anti-inflammatory drugs can lead to gastrointestinal bleeding.
Sponsoring Organizations:
  • American Headache Society
  • Sources:
  • American Academy of Neurology guidelines
  • Disciplines:
  • Neurologic
  • References: • Bigal ME, Serrano D, Buse D, Scher A, Stewart WF, Lipton RB. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache. 2008 Sep;48(8):1157-68.
    • Bigal ME, Lipton RB. Excessive acute migraine medication use and migraine progression. Neurology. 2008 Nov 25;71(22):1821-8.
    • Zwart JA, Dyb G, Hagen K, Svebak S, Holmen J. Analgesic use: a predictor of chronic pain and medication overuse headache—the Head-HUNT Study. Neurology. 2003;61:160-4.
    • Silberstein SD. Practice parameter: evidence-based guidelines for migraine headache (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2000;55:754-62.

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