Approximately 50% of patients with more than 15 headache days per month for at least three months have medication-overuse headache (MOH) as an additional underlying cause for the increasing frequency of headache days per month, in addition to their original primary headache disorder. Knowledge about medication-overuse headache (MOH) is a crucial component of treatment. With appropriate treatment, most affected individuals experience a significant improvement compared to their initial condition after a medication break

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

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

We have therefore derived the "10-20 rule" for preventing and recognizing medication overuse headache (MOH) from the limits on medication frequency specified in the International Classification of Headache Disorders (ICHD-3 beta). The upper limit was set at 10 days of medication use per month to increase safety, even though this threshold is set at 15 days per month for mono-analgesics. However, severely affected patients do not usually adhere to mono-analgesic treatment, so the 10-20 rule can generally be applied

  • Painkillers and specific migraine medications should be used on a maximum of 10 days per month
  • 20 days a month completely free from taking them.
  • This rule does not count the tablets used over the 10 days, but only the respective day, regardless of the amount taken.
  • This also means: It is better to treat with an adequate dose on one day than with too low a dose on several days.
  • Therefore, recording headache days and medication intake throughout the month using a pain diary is essential for modern headache therapy.

In principle, any medication effective in the acute treatment of primary headaches appears capable of causing headaches itself if used incorrectly. The crucial factor is the medication's usage pattern over time. A distinction is made between headaches induced by analgesics and those induced by ergotamines or triptans.