Approximately 50% of patients with more than 15 headache days per month for at least 3 months have, in addition to the original primary type of headache, medication overuse headache (MÜK) as a causal reason for the increasing frequency of headache days per month. Knowledge of medication overuse headache (MÜK) is a crucial component of treatment. Most of those affected show an adequate treatment in contrast to the initial situation after a medication break

  • a reduction in headache days per month
  • a renewed response to preventive and acute medication

Simple advice and knowledge of the connection and consequences of medication overuse headache (MÜK) are an essential component of the treatment. This knowledge alone can be enough to understand the processes, behave correctly and implement the 10-20 rule for prevention.

We have therefore derived the “10-20 rule” for avoiding and recognizing medication overuse headaches (MÜK) from the limitations on intake frequencies of the international headache classification (ICHD-3 beta). The upper limit was set at 10 days of intake per month to increase safety, even if this threshold for monoanalgesics is set at 15 days per month. However, severely affected patients usually do not undergo exclusive mono-analgesic treatment, so the 10-20 rule can generally be used:

  • Painkillers and specific migraine medications should be used a maximum of 10 days per month
  • 20 days a month should be completely free from taking them.
  • This rule does not count the tablets used over the 10 days, but only the day in question, regardless of the amount taken.
  • This also means: It is better to treat on one day with an adequate dose than on several days with an insufficient dose.
  • Recording headache days and medication intake over the course of the month using a pain calendar is therefore essential for contemporary headache therapy.

In principle, any medication that is effective in the acute treatment of primary headaches appears to be capable of causing headaches if used incorrectly. The decisive factor is the income behavior over time. A distinction is made between painkiller-induced headaches and ergotamine- or triptan-induced headaches.