A Complex Phenomenon: Medication Overuse Headache and Childhood Experiences

Adverse Childhood Experiences and Medication Overuse Headache: Burden and Treatment Impact" by Sandoe et al. 1 The authors have concluded that patients with adverse childhood experiences (ACEs) reported more opioid overuse and worse headache-related disability at follow-up, despite similar monthly headache days.However, we wish to add a few points.The authors have mentioned the prevalence of codeine and non-codeine opioid use in patients with medication overuse headache (MOH) at baseline and follow-up.However, they have not indicated whether the prevalence of triptan and non-steroidal anti-inflammatory drug use was also different in those with and without ACEs.Furthermore, the authors did not employ any scale to determine the severity of medication overuse, such as the Severity of Dependence Scale (SDS).Previous studies have suggested that up to 50% of patients with MOH exhibit signs of moderate to severe dependence on analgesics. 2 Providing this information would have been more informative for readers.