Medication-Overuse Headache: Missed Opportunities for Early Recognition and Prevention

Medication-overuse headache (MOH) can persist for years before diagnosis, alongside frequent headaches and repeated use of acute medication with limited benefit. We want to emphasize opportunities for earlier recognition and prevention during routine headache care. Previously published clinical observations provide a starting point for discussing prolonged medication use before diagnosis, while acknowledging that symptom duration alone cannot establish why recognition was delayed or whether earlier intervention would have prevented disability. Potential gaps include incomplete assessment of medication-use days, attention to individual attacks without reviewing the monthly headache pattern, and insufficient links between advice, treatment changes, and follow-up. A practical approach is proposed that combines assessment of headache frequency, medication use, treatment benefit, and daily functioning with patient education and an individualized management plan. Recent evidence on preventive treatment supports addressing the underlying migraine while medication overuse is being managed in selected patients. The accompanying table and figure organize existing recommendations into questions and actions for clinical consultations; they do not represent validated assessment tools. Research priorities include documenting care before diagnosis and evaluating whether structured assessment improves diagnostic accuracy, time to recognition, headache outcomes, and patient experience. Earlier recognition should lead to a feasible treatment plan, support for medication changes, and follow-up that assesses both medication use and headache control.