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1. Shard Calculation

Query:

Response:

Calculated Shard: 143 (from laksa081)

2. Crawled Status Check

Query:

curl -X POST \
  'http://laksa143.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://weillcornell.org/news/medication-overuse-headache-moh\')), getAhrefsUnparsedNoserviceFromURL(\'https://weillcornell.org/news/medication-overuse-headache-moh\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/weillcornell.org\/news\/medication-overuse-headache-moh","crawl_time":1774899742,"first_indexed_time":1723745940,"http_code":200,"src_unparsed":"org,weillcornell!\/news\/medication-overuse-headache-moh s443","src_root_hash":"10988755560325837143","history_drop_reason":null,"meta_title":"Medication-Overuse Headache (MOH) | Patient Care","meta_descriptions":["When a headache sufferer uses headache medications too often—especially “acute” medications that aim to relieve an individual headache attack—they may develop a disorder known as medication overuse headache (MOH)."],"attrs_boilerpipe_text":"When you have a headache, the first thing\nyou\nreach for is medication to take away the pain. Pain relief comes in the form of over-the-counter medications such as ibuprofen or\nacetaminophen (Tylenol)\n, or stronger medication pre\ns\ncribed by your doctor.\nEither way,\ni\nt makes sense\nto take a pain reliever when you’re in pain.\n \nHowever, there’s such a thing as too much of a good thing. When a headache sufferer uses headache medications too often\n—especially “acute” medications\nthat aim to relieve\nan individual headache attack—\nthey\nmay\ndevelop a disorder known as medication-overuse headache\n(MOH).\n \nTo unpack this paradoxical condition, Dr. Moises Dominguez, an Assistant Professor of Clinical Neurology, Assistant Attending Neurologist and headache specialist at Weill Cornell Medicine, provides answers to your FAQs, along with the best ways to deal\nwith MOH\n.\n \nWho may be vulnerable to medication\noveruse headache\n(MOH)?\n \nMOH usually affects people who already have a\nn underlying\nheadache disorder\n, such as\nmigraine\nor\ntension-type headache\n.\n \nWhat are the diagnostic criteria for MOH?\n \nA person is said to have MOH if they meet the following criteria:\n \nThey have headaches on 15 or more days per month and already have an underlying headache disorder.\n \nThey regularly overuse medications to treat each headache attack.\n \nThey have been overusing medications for more than 3 months.\n \nTheir frequent headaches are not due to another underlying cause.\n \nWhat is considered “overuse”?\n \n“\nGenerally,\n” says Dr. Dominguez, “\ncertain\nacute or\n‘\nuse\nas needed\n’\nmedications have the potential to cause\nMOH\n.” These may include:\n \nSimple analgesics, such as acetaminophen, ibuprofen, naproxen or aspirin: Using these on 15 or more days per month for more than 3 months can lead to MOH.\n \nCombined pain relievers, such as acetaminophen-aspirin-caffeine and butalbital-acetaminophen-caffeine: Using these on 10 or more days per month for more than 3 months can lead to MOH. \n \nTriptans, such as sumatriptan and rizatriptan, and ergotamines, such as dihydroergotamine: Using these on 10 or more days per month for more than 3 months can lead to MOH.\n \nOpioids, such as tramadol, codeine and and oxycodone: Using these on 10 or more days per month for more than 3 months can lead to MOH. \n \nWhat are\nthe\nsymptoms\nof MOH\n?\n  \n“The\nsymptoms\nof MOH\ncan vary\nwidely,” he says. “I\nt depends on\nthe type of underlying\nheadache disorder\na person has and the medication or combination of medications being\noverused.\nHowever, the key symptom is\nexperienc\ning headache\non\nmore days\nper month\nt\nhan not\n; specifically,\nat least 15 days\nper\nmonth.\n”\n \nAre the symptoms comparable to migraine?\n \nMOH can present with frequent headaches that have a migraine presentation\n:\na throbbing headache of moderate-to-severe intensity, often associated with\nnausea, vomiting, and\nsensitivity to light and noise\n.\n \n \nHow do you diagnose MOH?\n \nDiagnosing\nMOH\nbegins\nwith a detailed medical history and a thorough neurological examination\n, Dr. Dominguez says. “\nThe clinician will look for specific signs in the\npatient’s\nheadache history that might require additional tests,\nincluding\nblood tests and brain imaging.\n \n“\nPatients are\nalso\nencouraged to keep a headache diary\n,” he continues. “\nTh\ne\ndiary is crucial for diagnosing MOH, as it helps track how often headaches occur, the associated symptoms, the medications used and how often\n.”\n \nIf a person meets the diagnostic criteria for MOH (mentioned earlier), they are diagnosed with MOH.\n \nHow is MOH\ntreated?\n \nThe first step in treating\nMOH\nis to educate the patient on what\nthe disorder\nis and why it occurs\n, he explains. \n \n“\nIt's important to understand that medication overuse is not the patient\n’\ns fault\n. I\nt simply means that the treatment plan needs to be optimized\n,” says Dr. Dominguez.\n \nTreatment includes prescribing effective\npreventive medications\nto reduce the overall burden of headaches\n, meaning\nthe\nir\nfrequency\nand\nseverity\n, as well as\nany\ndisability\nthey cause.\nA\ndditionally\n, patients are\nadvised to discontinue or limit the use of the overused medication.\nIn cases where\nthat\nis challenging, bridge therapy, such as steroids or long-acting NSAIDs, may be considered\nas a way to\nhelp patients discontinue the overused medication.\n \nRegular follow-up\nvisits\nwith a\nspecialist\nare\nimportant to ensure that the patient\n’\ns headaches are well\n-\ncontrolled\n, he advises.\n \nSummary\n \nMedication overuse headache (MOH) generally affects people who already have a headache disorder.\n \nIf a patient has headaches on 15 or more days a month, regularly overuses medication and has been doing so for more than 3 months, and no other cause of frequent headaches is found, they may have MOH.\n \nBoth OTC and certain prescription medications can be overused.\n \nSpecialists treat MOH by educating their patients about the condition, advising them to discontinue or limit the overused medication and prescribing effective preventive medication.\n \n“Overuse” is not the patient’s fault. It’s normal to seek pain relief when dealing with pain. A headache specialist can help you downsize your use of the problematic medication and prescribe a preventive medication to reduce the frequency and severity of your headaches.\n ","attrs_markdown":"[Skip to main content](https:\/\/weillcornell.org\/news\/medication-overuse-headache-moh#site-main)\n\nRead about upcoming changes to [**UnitedHealthcare**](https:\/\/www.nyp.org\/unitedhealthcare) coverage.\n\nMenu\n\n[![Weill Cornell Medicine](https:\/\/weillcornell.org\/profiles\/wcmc\/themes\/wcm_brand_base\/images\/wcm_logo.svg) ![Weill Cornell Medicine](https:\/\/weillcornell.org\/profiles\/wcmc\/themes\/wcm_brand_base\/images\/WCM_logo_white.png)](https:\/\/weillcornell.org\/)\n\n- [Clinical Services](https:\/\/weillcornell.org\/services)\n- [Digital Health Services](https:\/\/weillcornell.org\/digital-health-services)\n- [Patient Education](https:\/\/weillcornell.org\/patient-education)\n- [About Us](https:\/\/weillcornell.org\/about_us)\n- [Here's What We Know](https:\/\/weillcornell.org\/heres-what-we-know)\n\n[Patient Login](https:\/\/weillcornell.org\/weill-cornell-connect)\n\n[Find a Doctor](https:\/\/weillcornell.org\/doctors)\n\nExplore this Website\n\n[Patient Login](https:\/\/weillcornell.org\/weill-cornell-connect)\n\n[Find a Doctor](https:\/\/weillcornell.org\/doctors)\n\n- [Home](https:\/\/weillcornell.org\/)\n- [Clinical Services](https:\/\/weillcornell.org\/services)\n- [Digital Health Services](https:\/\/weillcornell.org\/digital-health-services)\n  Toggle Digital Health Services menu options\n  - 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Pain relief comes in the form of over-the-counter medications such as ibuprofen or acetaminophen (Tylenol), or stronger medication prescribed by your doctor. Either way, it makes sense to take a pain reliever when you’re in pain.\n\nHowever, there’s such a thing as too much of a good thing. When a headache sufferer uses headache medications too often—especially “acute” medications that aim to relieve an individual headache attack—they may develop a disorder known as medication-overuse headache (MOH).\n\nTo unpack this paradoxical condition, Dr. Moises Dominguez, an Assistant Professor of Clinical Neurology, Assistant Attending Neurologist and headache specialist at Weill Cornell Medicine, provides answers to your FAQs, along with the best ways to deal with MOH.\n\n## Who may be vulnerable to medication overuse headache (MOH)?\nMOH usually affects people who already have an underlying headache disorder, such as migraine or tension-type headache.\n\n## What are the diagnostic criteria for MOH?\nA person is said to have MOH if they meet the following criteria:\n\n- They have headaches on 15 or more days per month and already have an underlying headache disorder.\n- They regularly overuse medications to treat each headache attack.\n- They have been overusing medications for more than 3 months.\n- Their frequent headaches are not due to another underlying cause.\n\n## What is considered “overuse”?\n“Generally,” says Dr. Dominguez, “certain acute or ‘use as needed’ medications have the potential to cause MOH.” These may include:\n\n- Simple analgesics, such as acetaminophen, ibuprofen, naproxen or aspirin: Using these on 15 or more days per month for more than 3 months can lead to MOH.\n- Combined pain relievers, such as acetaminophen-aspirin-caffeine and butalbital-acetaminophen-caffeine: Using these on 10 or more days per month for more than 3 months can lead to MOH.\n- Triptans, such as sumatriptan and rizatriptan, and ergotamines, such as dihydroergotamine: Using these on 10 or more days per month for more than 3 months can lead to MOH.\n- Opioids, such as tramadol, codeine and and oxycodone: Using these on 10 or more days per month for more than 3 months can lead to MOH.\n## What are the symptoms of MOH?\n“The symptoms of MOH can vary widely,” he says. “It depends on the type of underlying headache disorder a person has and the medication or combination of medications being overused. However, the key symptom is experiencing headache on more days per month than not; specifically, at least 15 days per month.”\n\n## Are the symptoms comparable to migraine?\nMOH can present with frequent headaches that have a migraine presentation: a throbbing headache of moderate-to-severe intensity, often associated with nausea, vomiting, and sensitivity to light and noise.\n\n## How do you diagnose MOH?\nDiagnosing MOH begins with a detailed medical history and a thorough neurological examination, Dr. Dominguez says. “The clinician will look for specific signs in the patient’s headache history that might require additional tests, including blood tests and brain imaging.\n\n“Patients are also encouraged to keep a headache diary,” he continues. “The diary is crucial for diagnosing MOH, as it helps track how often headaches occur, the associated symptoms, the medications used and how often.”\n\nIf a person meets the diagnostic criteria for MOH (mentioned earlier), they are diagnosed with MOH.\n\n## How is MOH treated?\nThe first step in treating MOH is to educate the patient on what the disorder is and why it occurs, he explains.\n\n“It's important to understand that medication overuse is not the patient’s fault. It simply means that the treatment plan needs to be optimized,” says Dr. Dominguez.\n\nTreatment includes prescribing effective [preventive medications](https:\/\/americanmigrainefoundation.org\/resource-library\/migraine-prevention-101\/) to reduce the overall burden of headaches, meaning their frequency and severity, as well as any disability they cause. Additionally, patients are advised to discontinue or limit the use of the overused medication. In cases where that is challenging, bridge therapy, such as steroids or long-acting NSAIDs, may be considered as a way to help patients discontinue the overused medication.\n\nRegular follow-up visits with a specialist are important to ensure that the patient’s headaches are well\\-controlled, he advises.\n\n## Summary\n- Medication overuse headache (MOH) generally affects people who already have a headache disorder.\n- If a patient has headaches on 15 or more days a month, regularly overuses medication and has been doing so for more than 3 months, and no other cause of frequent headaches is found, they may have MOH.\n- Both OTC and certain prescription medications can be overused.\n- Specialists treat MOH by educating their patients about the condition, advising them to discontinue or limit the overused medication and prescribing effective preventive medication.\n- “Overuse” is not the patient’s fault. It’s normal to seek pain relief when dealing with pain. A headache specialist can help you downsize your use of the problematic medication and prescribe a preventive medication to reduce the frequency and severity of your headaches.\n\n***Make an appointment with a Weill Cornell Medicine headache specialist by [visiting the Headache Program’s website](https:\/\/weillcornell.org\/services\/neurology\/headache-program) or calling (212) 746-2596.***\n\n### Related Links\n[Podcast: Migraine and Headache Awareness](https:\/\/weillcornell.org\/news\/podcast-migraine-and-headache-awareness) [Podcast: Long-COVID Headache](https:\/\/weillcornell.org\/news\/podcast-long-covid-headache) [Infographic: Migraines vs Headaches](https:\/\/weillcornell.org\/news\/infographic-migraines-vs-headaches) [Headache: A Common Long COVID Symptom](https:\/\/weillcornell.org\/news\/headache-a-common-long-covid-symptom) [Migraine and Headache Awareness Month](https:\/\/weillcornell.org\/news\/migraine-and-headache-awareness-month)\n\n[Back to News](https:\/\/weillcornell.org\/news)\n\n### In This Article\n### Clinical Service\n[Neurology](https:\/\/weillcornell.org\/services\/neurology)\n\n### Practice\n[General Neurology](https:\/\/weillcornell.org\/general-neurology) [Headache](https:\/\/weillcornell.org\/headache-pain)\n\n### Physician\n[Moises Dominguez](https:\/\/weillcornell.org\/moises-dominguez-md)\n\n- [Twitter](https:\/\/twitter.com\/WeillCornell)\n- [Facebook](https:\/\/www.facebook.com\/WeillCornellMedicine)\n- [Instagram](https:\/\/www.instagram.com\/weillcornell\/)\n- [YouTube](https:\/\/www.youtube.com\/user\/WCMCnews)\n\n- [Find a Doctor](https:\/\/weillcornell.org\/doctors)\n- WCM App\n\n- [![MyChart for iOS](https:\/\/weillcornell.org\/sites\/all\/themes\/weillcornell\/images\/badge_apple.png)](https:\/\/itunes.apple.com\/us\/app\/weill-cornell-medicine\/id1381440520?ls=1&mt=8)\n- [![MyChart for Android](https:\/\/weillcornell.org\/sites\/all\/themes\/weillcornell\/images\/badge_android.png)](https:\/\/play.google.com\/store\/apps\/details?id=org.weillcornell.mobile)\n\n- - [Weill Cornell Connect](https:\/\/weillcornell.org\/weill-cornell-connect)\n    - [Patient Login](https:\/\/weillcornell.org\/weill-cornell-connect)\n    - [Sign Up](https:\/\/mychart.weill.cornell.edu\/mychart\/accesscheck.asp)\n    - [Forgot Username](https:\/\/mychart.weill.cornell.edu\/mychart\/recoverlogin.asp)\n    - [Forgot Password](https:\/\/mychart.weill.cornell.edu\/mychart\/passwordreset.asp)\n    - [Test Results](https:\/\/weillcornell.org\/weill-cornell-connect\/test-results)\n    - [eCheck-in](https:\/\/weillcornell.org\/weill-cornell-connect\/echeck-in)\n    - [Bill Pay](https:\/\/weillcornell.org\/weill-cornell-connect\/how-to-pay-your-bill)\n    - [FAQ](https:\/\/mychart.weill.cornell.edu\/mychart\/default.asp?mode=stdfile&option=faq)\n  - [Coronavirus (COVID-19)](https:\/\/weillcornell.org\/coronavirus)\n- - [Clinical Services](https:\/\/weillcornell.org\/services)\n  - [Digital Health Services](https:\/\/weillcornell.org\/digital-health-services)\n    - [Video Visits](https:\/\/weillcornell.org\/digital-health-services\/video-visits)\n    - [Virtual Urgent Care](https:\/\/www.nyp.org\/ondemand\/urgent-care)\n  - [International Patient Services](https:\/\/weillcornell.org\/clinical-services\/international-patient-services)\n  - [Clinical Trials](https:\/\/weillcornell.org\/referring_physicians\/clinical-trials)\n  - [Here's What We Know](https:\/\/weillcornell.org\/heres-what-we-know)\n- - [About Us](https:\/\/weillcornell.org\/about_us)\n    - [Patient Safety](https:\/\/weillcornell.org\/about-us\/patient-safety)\n  - [What Our Patients Are Saying](https:\/\/weillcornell.org\/about-us\/what-our-patients-are-saying)\n  - [Patient Education](https:\/\/weillcornell.org\/patient-education)\n    - [E-Newsletter Signup](https:\/\/weillcornell.org\/patient-education\/e-newsletter-signup)\n    - [Health Library](https:\/\/www.healthwise.net\/weillcornell)\n    - [Health Podcasts](https:\/\/weillcornell.org\/patient-education\/podcasts)\n    - [LGBTQ+ Community Healthcare Resources](https:\/\/weillcornell.org\/patient-education\/lgbtq-community-healthcare-resources)\n    - [Patient Care Blog](https:\/\/weillcornell.org\/news)\n    - [Patient Resource Center](https:\/\/weillcornell.org\/patient-education\/myra-mahon-patient-resource-center)\n- - [Contact Us](https:\/\/weillcornell.org\/contact)\n  - [Referring Physicians](https:\/\/weillcornell.org\/referring_physicians)\n  - [Careers](https:\/\/weillcornell.org\/about-us\/careers)\n  - [Giving](https:\/\/give.weill.cornell.edu\/)\n\n**Care. Discover. Teach.** With a legacy of putting patients first, Weill Cornell Medicine is committed to providing exemplary and individualized clinical care, making groundbreaking biomedical discoveries, and educating generations of exceptional doctors and scientists.\n\n[Weill Cornell Medicine](https:\/\/weill.cornell.edu\/) [NewYork - Presbyterian](https:\/\/nyp.org\/)\n\n© Weill Cornell Medicine.\n\n- [Website Privacy Policy](https:\/\/weill.cornell.edu\/website-privacy-policy)\n- [Terms of Use](https:\/\/weillcornell.org\/terms-of-use)\n- [Notice of Privacy Practices](https:\/\/weillcornell.org\/privacy)\n- [Equal Education & Employment](https:\/\/careers.weill.cornell.edu\/about-weill-cornell\/wcm-eeo-statement)\n- [Web Accessibility Assistance](https:\/\/weill.cornell.edu\/accessibility)","attrs_readable_markdown":"When you have a headache, the first thing you reach for is medication to take away the pain. Pain relief comes in the form of over-the-counter medications such as ibuprofen or acetaminophen (Tylenol), or stronger medication prescribed by your doctor. Either way, it makes sense to take a pain reliever when you’re in pain.\n\nHowever, there’s such a thing as too much of a good thing. When a headache sufferer uses headache medications too often—especially “acute” medications that aim to relieve an individual headache attack—they may develop a disorder known as medication-overuse headache (MOH).\n\nTo unpack this paradoxical condition, Dr. Moises Dominguez, an Assistant Professor of Clinical Neurology, Assistant Attending Neurologist and headache specialist at Weill Cornell Medicine, provides answers to your FAQs, along with the best ways to deal with MOH.\n\nWho may be vulnerable to medication overuse headache (MOH)?\n\nMOH usually affects people who already have an underlying headache disorder, such as migraine or tension-type headache.\n\nWhat are the diagnostic criteria for MOH?\n\nA person is said to have MOH if they meet the following criteria:\n\n- They have headaches on 15 or more days per month and already have an underlying headache disorder.\n- They regularly overuse medications to treat each headache attack.\n- They have been overusing medications for more than 3 months.\n- Their frequent headaches are not due to another underlying cause.\n\nWhat is considered “overuse”?\n\n“Generally,” says Dr. Dominguez, “certain acute or ‘use as needed’ medications have the potential to cause MOH.” These may include:\n\n- Simple analgesics, such as acetaminophen, ibuprofen, naproxen or aspirin: Using these on 15 or more days per month for more than 3 months can lead to MOH.\n- Combined pain relievers, such as acetaminophen-aspirin-caffeine and butalbital-acetaminophen-caffeine: Using these on 10 or more days per month for more than 3 months can lead to MOH.\n- Triptans, such as sumatriptan and rizatriptan, and ergotamines, such as dihydroergotamine: Using these on 10 or more days per month for more than 3 months can lead to MOH.\n- Opioids, such as tramadol, codeine and and oxycodone: Using these on 10 or more days per month for more than 3 months can lead to MOH.\n\nWhat are the symptoms of MOH?\n\n“The symptoms of MOH can vary widely,” he says. “It depends on the type of underlying headache disorder a person has and the medication or combination of medications being overused. However, the key symptom is experiencing headache on more days per month than not; specifically, at least 15 days per month.”\n\nAre the symptoms comparable to migraine?\n\nMOH can present with frequent headaches that have a migraine presentation: a throbbing headache of moderate-to-severe intensity, often associated with nausea, vomiting, and sensitivity to light and noise.\n\nHow do you diagnose MOH?\n\nDiagnosing MOH begins with a detailed medical history and a thorough neurological examination, Dr. Dominguez says. “The clinician will look for specific signs in the patient’s headache history that might require additional tests, including blood tests and brain imaging.\n\n“Patients are also encouraged to keep a headache diary,” he continues. “The diary is crucial for diagnosing MOH, as it helps track how often headaches occur, the associated symptoms, the medications used and how often.”\n\nIf a person meets the diagnostic criteria for MOH (mentioned earlier), they are diagnosed with MOH.\n\nHow is MOH treated?\n\nThe first step in treating MOH is to educate the patient on what the disorder is and why it occurs, he explains.\n\n“It's important to understand that medication overuse is not the patient’s fault. It simply means that the treatment plan needs to be optimized,” says Dr. Dominguez.\n\nTreatment includes prescribing effective [preventive medications](https:\/\/americanmigrainefoundation.org\/resource-library\/migraine-prevention-101\/) to reduce the overall burden of headaches, meaning their frequency and severity, as well as any disability they cause. Additionally, patients are advised to discontinue or limit the use of the overused medication. In cases where that is challenging, bridge therapy, such as steroids or long-acting NSAIDs, may be considered as a way to help patients discontinue the overused medication.\n\nRegular follow-up visits with a specialist are important to ensure that the patient’s headaches are well\\-controlled, he advises.\n\nSummary\n\n- Medication overuse headache (MOH) generally affects people who already have a headache disorder.\n- If a patient has headaches on 15 or more days a month, regularly overuses medication and has been doing so for more than 3 months, and no other cause of frequent headaches is found, they may have MOH.\n- Both OTC and certain prescription medications can be overused.\n- Specialists treat MOH by educating their patients about the condition, advising them to discontinue or limit the overused medication and prescribing effective preventive medication.\n- “Overuse” is not the patient’s fault. It’s normal to seek pain relief when dealing with pain. A headache specialist can help you downsize your use of the problematic medication and prescribe a preventive medication to reduce the frequency and severity of your headaches.","meta_canonical":null}

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Meta Title	Medication-Overuse Headache (MOH) \| Patient Care
Meta Description	When a headache sufferer uses headache medications too often—especially “acute” medications that aim to relieve an individual headache attack—they may develop a disorder known as medication overuse headache (MOH).
Meta Canonical	null
Boilerpipe Text	When you have a headache, the first thing you reach for is medication to take away the pain. Pain relief comes in the form of over-the-counter medications such as ibuprofen or acetaminophen (Tylenol) , or stronger medication pre s cribed by your doctor. Either way, i t makes sense to take a pain reliever when you’re in pain. However, there’s such a thing as too much of a good thing. When a headache sufferer uses headache medications too often —especially “acute” medications that aim to relieve an individual headache attack— they may develop a disorder known as medication-overuse headache (MOH). To unpack this paradoxical condition, Dr. Moises Dominguez, an Assistant Professor of Clinical Neurology, Assistant Attending Neurologist and headache specialist at Weill Cornell Medicine, provides answers to your FAQs, along with the best ways to deal with MOH . Who may be vulnerable to medication overuse headache (MOH)? MOH usually affects people who already have a n underlying headache disorder , such as migraine or tension-type headache . What are the diagnostic criteria for MOH? A person is said to have MOH if they meet the following criteria: They have headaches on 15 or more days per month and already have an underlying headache disorder. They regularly overuse medications to treat each headache attack. They have been overusing medications for more than 3 months. Their frequent headaches are not due to another underlying cause. What is considered “overuse”? “ Generally, ” says Dr. Dominguez, “ certain acute or ‘ use as needed ’ medications have the potential to cause MOH .” These may include: Simple analgesics, such as acetaminophen, ibuprofen, naproxen or aspirin: Using these on 15 or more days per month for more than 3 months can lead to MOH. Combined pain relievers, such as acetaminophen-aspirin-caffeine and butalbital-acetaminophen-caffeine: Using these on 10 or more days per month for more than 3 months can lead to MOH. Triptans, such as sumatriptan and rizatriptan, and ergotamines, such as dihydroergotamine: Using these on 10 or more days per month for more than 3 months can lead to MOH. Opioids, such as tramadol, codeine and and oxycodone: Using these on 10 or more days per month for more than 3 months can lead to MOH. What are the symptoms of MOH ?   “The symptoms of MOH can vary widely,” he says. “I t depends on the type of underlying headache disorder a person has and the medication or combination of medications being overused. However, the key symptom is experienc ing headache on more days per month t han not ; specifically, at least 15 days per month. ” Are the symptoms comparable to migraine? MOH can present with frequent headaches that have a migraine presentation : a throbbing headache of moderate-to-severe intensity, often associated with nausea, vomiting, and sensitivity to light and noise . How do you diagnose MOH? Diagnosing MOH begins with a detailed medical history and a thorough neurological examination , Dr. Dominguez says. “ The clinician will look for specific signs in the patient’s headache history that might require additional tests, including blood tests and brain imaging. “ Patients are also encouraged to keep a headache diary ,” he continues. “ Th e diary is crucial for diagnosing MOH, as it helps track how often headaches occur, the associated symptoms, the medications used and how often .” If a person meets the diagnostic criteria for MOH (mentioned earlier), they are diagnosed with MOH. How is MOH treated? The first step in treating MOH is to educate the patient on what the disorder is and why it occurs , he explains. “ It's important to understand that medication overuse is not the patient ’ s fault . I t simply means that the treatment plan needs to be optimized ,” says Dr. Dominguez. Treatment includes prescribing effective preventive medications to reduce the overall burden of headaches , meaning the ir frequency and severity , as well as any disability they cause. A dditionally , patients are advised to discontinue or limit the use of the overused medication. In cases where that is challenging, bridge therapy, such as steroids or long-acting NSAIDs, may be considered as a way to help patients discontinue the overused medication. Regular follow-up visits with a specialist are important to ensure that the patient ’ s headaches are well - controlled , he advises. Summary Medication overuse headache (MOH) generally affects people who already have a headache disorder. If a patient has headaches on 15 or more days a month, regularly overuses medication and has been doing so for more than 3 months, and no other cause of frequent headaches is found, they may have MOH. Both OTC and certain prescription medications can be overused. Specialists treat MOH by educating their patients about the condition, advising them to discontinue or limit the overused medication and prescribing effective preventive medication. “Overuse” is not the patient’s fault. It’s normal to seek pain relief when dealing with pain. A headache specialist can help you downsize your use of the problematic medication and prescribe a preventive medication to reduce the frequency and severity of your headaches.
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[About Us](https://weillcornell.org/about_us) - [Here's What We Know](https://weillcornell.org/heres-what-we-know) - [Home](https://weillcornell.org/) - [News](https://weillcornell.org/news) # Medication-Overuse Headache (MOH) August 14, 2024 - [Share to Facebook](https://facebook.com/sharer/sharer.php?u=https%3A//weillcornell.org/news/medication-overuse-headache-moh) - [Share to Twitter](https://twitter.com/intent/tweet/?text=Medication-Overuse%20Headache%20\(MOH\)&url=https%3A//weillcornell.org/news/medication-overuse-headache-moh) - [Share to LinkedIn](http://www.linkedin.com/shareArticle?mini=true&url=https%3A//weillcornell.org/news/medication-overuse-headache-moh&title=Medication-Overuse%20Headache%20\(MOH\)&summary=&source=https%3A//weillcornell.org/news/medication-overuse-headache-moh) - [Share on Email](<mailto:?subject=Read more about Medication-Overuse Headache (MOH)&body=Please click the following link to read more about Medication-Overuse Headache (MOH) %0D%0A https%3A//weillcornell.org/news/medication-overuse-headache-moh>) ![Opioid epidemic, painkillers and drug abuse concept with close up on a bottle of prescription drugs and hydrocodone pills falling out of it on white](https://weillcornell.org/sites/default/files/styles/custom__1440x960_/public/news_images/shutterstock_1756011149.jpg?itok=PNyfMBA7) When you have a headache, the first thing you reach for is medication to take away the pain. Pain relief comes in the form of over-the-counter medications such as ibuprofen or acetaminophen (Tylenol), or stronger medication prescribed by your doctor. Either way, it makes sense to take a pain reliever when you’re in pain. However, there’s such a thing as too much of a good thing. When a headache sufferer uses headache medications too often—especially “acute” medications that aim to relieve an individual headache attack—they may develop a disorder known as medication-overuse headache (MOH). To unpack this paradoxical condition, Dr. Moises Dominguez, an Assistant Professor of Clinical Neurology, Assistant Attending Neurologist and headache specialist at Weill Cornell Medicine, provides answers to your FAQs, along with the best ways to deal with MOH. ## Who may be vulnerable to medication overuse headache (MOH)? MOH usually affects people who already have an underlying headache disorder, such as migraine or tension-type headache. ## What are the diagnostic criteria for MOH? A person is said to have MOH if they meet the following criteria: - They have headaches on 15 or more days per month and already have an underlying headache disorder. - They regularly overuse medications to treat each headache attack. - They have been overusing medications for more than 3 months. - Their frequent headaches are not due to another underlying cause. ## What is considered “overuse”? “Generally,” says Dr. Dominguez, “certain acute or ‘use as needed’ medications have the potential to cause MOH.” These may include: - Simple analgesics, such as acetaminophen, ibuprofen, naproxen or aspirin: Using these on 15 or more days per month for more than 3 months can lead to MOH. - Combined pain relievers, such as acetaminophen-aspirin-caffeine and butalbital-acetaminophen-caffeine: Using these on 10 or more days per month for more than 3 months can lead to MOH. - Triptans, such as sumatriptan and rizatriptan, and ergotamines, such as dihydroergotamine: Using these on 10 or more days per month for more than 3 months can lead to MOH. - Opioids, such as tramadol, codeine and and oxycodone: Using these on 10 or more days per month for more than 3 months can lead to MOH. ## What are the symptoms of MOH? “The symptoms of MOH can vary widely,” he says. “It depends on the type of underlying headache disorder a person has and the medication or combination of medications being overused. However, the key symptom is experiencing headache on more days per month than not; specifically, at least 15 days per month.” ## Are the symptoms comparable to migraine? MOH can present with frequent headaches that have a migraine presentation: a throbbing headache of moderate-to-severe intensity, often associated with nausea, vomiting, and sensitivity to light and noise. ## How do you diagnose MOH? Diagnosing MOH begins with a detailed medical history and a thorough neurological examination, Dr. Dominguez says. “The clinician will look for specific signs in the patient’s headache history that might require additional tests, including blood tests and brain imaging. “Patients are also encouraged to keep a headache diary,” he continues. “The diary is crucial for diagnosing MOH, as it helps track how often headaches occur, the associated symptoms, the medications used and how often.” If a person meets the diagnostic criteria for MOH (mentioned earlier), they are diagnosed with MOH. ## How is MOH treated? The first step in treating MOH is to educate the patient on what the disorder is and why it occurs, he explains. “It's important to understand that medication overuse is not the patient’s fault. It simply means that the treatment plan needs to be optimized,” says Dr. Dominguez. Treatment includes prescribing effective [preventive medications](https://americanmigrainefoundation.org/resource-library/migraine-prevention-101/) to reduce the overall burden of headaches, meaning their frequency and severity, as well as any disability they cause. Additionally, patients are advised to discontinue or limit the use of the overused medication. In cases where that is challenging, bridge therapy, such as steroids or long-acting NSAIDs, may be considered as a way to help patients discontinue the overused medication. Regular follow-up visits with a specialist are important to ensure that the patient’s headaches are well\-controlled, he advises. ## Summary - Medication overuse headache (MOH) generally affects people who already have a headache disorder. - If a patient has headaches on 15 or more days a month, regularly overuses medication and has been doing so for more than 3 months, and no other cause of frequent headaches is found, they may have MOH. - Both OTC and certain prescription medications can be overused. - Specialists treat MOH by educating their patients about the condition, advising them to discontinue or limit the overused medication and prescribing effective preventive medication. - “Overuse” is not the patient’s fault. It’s normal to seek pain relief when dealing with pain. A headache specialist can help you downsize your use of the problematic medication and prescribe a preventive medication to reduce the frequency and severity of your headaches. *Make an appointment with a Weill Cornell Medicine headache specialist by [visiting the Headache Program’s website](https://weillcornell.org/services/neurology/headache-program) or calling (212) 746-2596.* ### Related Links [Podcast: Migraine and Headache Awareness](https://weillcornell.org/news/podcast-migraine-and-headache-awareness) [Podcast: Long-COVID Headache](https://weillcornell.org/news/podcast-long-covid-headache) [Infographic: Migraines vs Headaches](https://weillcornell.org/news/infographic-migraines-vs-headaches) [Headache: A Common Long COVID Symptom](https://weillcornell.org/news/headache-a-common-long-covid-symptom) [Migraine and Headache Awareness Month](https://weillcornell.org/news/migraine-and-headache-awareness-month) [Back to News](https://weillcornell.org/news) ### In This Article ### Clinical Service [Neurology](https://weillcornell.org/services/neurology) ### Practice [General Neurology](https://weillcornell.org/general-neurology) [Headache](https://weillcornell.org/headache-pain) ### Physician [Moises Dominguez](https://weillcornell.org/moises-dominguez-md) - [Twitter](https://twitter.com/WeillCornell) - [Facebook](https://www.facebook.com/WeillCornellMedicine) - [Instagram](https://www.instagram.com/weillcornell/) - [YouTube](https://www.youtube.com/user/WCMCnews) - [Find a Doctor](https://weillcornell.org/doctors) - WCM App - [![MyChart for iOS](https://weillcornell.org/sites/all/themes/weillcornell/images/badge_apple.png)](https://itunes.apple.com/us/app/weill-cornell-medicine/id1381440520?ls=1&mt=8) - [![MyChart for Android](https://weillcornell.org/sites/all/themes/weillcornell/images/badge_android.png)](https://play.google.com/store/apps/details?id=org.weillcornell.mobile) - - [Weill Cornell Connect](https://weillcornell.org/weill-cornell-connect) - [Patient Login](https://weillcornell.org/weill-cornell-connect) - [Sign Up](https://mychart.weill.cornell.edu/mychart/accesscheck.asp) - [Forgot Username](https://mychart.weill.cornell.edu/mychart/recoverlogin.asp) - [Forgot Password](https://mychart.weill.cornell.edu/mychart/passwordreset.asp) - [Test Results](https://weillcornell.org/weill-cornell-connect/test-results) - [eCheck-in](https://weillcornell.org/weill-cornell-connect/echeck-in) - [Bill Pay](https://weillcornell.org/weill-cornell-connect/how-to-pay-your-bill) - [FAQ](https://mychart.weill.cornell.edu/mychart/default.asp?mode=stdfile&option=faq) - [Coronavirus (COVID-19)](https://weillcornell.org/coronavirus) - - [Clinical Services](https://weillcornell.org/services) - [Digital Health Services](https://weillcornell.org/digital-health-services) - [Video Visits](https://weillcornell.org/digital-health-services/video-visits) - [Virtual Urgent Care](https://www.nyp.org/ondemand/urgent-care) - [International Patient Services](https://weillcornell.org/clinical-services/international-patient-services) - [Clinical Trials](https://weillcornell.org/referring_physicians/clinical-trials) - [Here's What We Know](https://weillcornell.org/heres-what-we-know) - - [About Us](https://weillcornell.org/about_us) - [Patient Safety](https://weillcornell.org/about-us/patient-safety) - [What Our Patients Are Saying](https://weillcornell.org/about-us/what-our-patients-are-saying) - [Patient Education](https://weillcornell.org/patient-education) - [E-Newsletter Signup](https://weillcornell.org/patient-education/e-newsletter-signup) - [Health Library](https://www.healthwise.net/weillcornell) - [Health Podcasts](https://weillcornell.org/patient-education/podcasts) - [LGBTQ+ Community Healthcare Resources](https://weillcornell.org/patient-education/lgbtq-community-healthcare-resources) - [Patient Care Blog](https://weillcornell.org/news) - [Patient Resource Center](https://weillcornell.org/patient-education/myra-mahon-patient-resource-center) - - [Contact Us](https://weillcornell.org/contact) - [Referring Physicians](https://weillcornell.org/referring_physicians) - [Careers](https://weillcornell.org/about-us/careers) - [Giving](https://give.weill.cornell.edu/) Care. 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Readable Markdown	When you have a headache, the first thing you reach for is medication to take away the pain. Pain relief comes in the form of over-the-counter medications such as ibuprofen or acetaminophen (Tylenol), or stronger medication prescribed by your doctor. Either way, it makes sense to take a pain reliever when you’re in pain. However, there’s such a thing as too much of a good thing. When a headache sufferer uses headache medications too often—especially “acute” medications that aim to relieve an individual headache attack—they may develop a disorder known as medication-overuse headache (MOH). To unpack this paradoxical condition, Dr. Moises Dominguez, an Assistant Professor of Clinical Neurology, Assistant Attending Neurologist and headache specialist at Weill Cornell Medicine, provides answers to your FAQs, along with the best ways to deal with MOH. Who may be vulnerable to medication overuse headache (MOH)? MOH usually affects people who already have an underlying headache disorder, such as migraine or tension-type headache. What are the diagnostic criteria for MOH? A person is said to have MOH if they meet the following criteria: - They have headaches on 15 or more days per month and already have an underlying headache disorder. - They regularly overuse medications to treat each headache attack. - They have been overusing medications for more than 3 months. - Their frequent headaches are not due to another underlying cause. What is considered “overuse”? “Generally,” says Dr. Dominguez, “certain acute or ‘use as needed’ medications have the potential to cause MOH.” These may include: - Simple analgesics, such as acetaminophen, ibuprofen, naproxen or aspirin: Using these on 15 or more days per month for more than 3 months can lead to MOH. - Combined pain relievers, such as acetaminophen-aspirin-caffeine and butalbital-acetaminophen-caffeine: Using these on 10 or more days per month for more than 3 months can lead to MOH. - Triptans, such as sumatriptan and rizatriptan, and ergotamines, such as dihydroergotamine: Using these on 10 or more days per month for more than 3 months can lead to MOH. - Opioids, such as tramadol, codeine and and oxycodone: Using these on 10 or more days per month for more than 3 months can lead to MOH. What are the symptoms of MOH? “The symptoms of MOH can vary widely,” he says. “It depends on the type of underlying headache disorder a person has and the medication or combination of medications being overused. However, the key symptom is experiencing headache on more days per month than not; specifically, at least 15 days per month.” Are the symptoms comparable to migraine? MOH can present with frequent headaches that have a migraine presentation: a throbbing headache of moderate-to-severe intensity, often associated with nausea, vomiting, and sensitivity to light and noise. How do you diagnose MOH? Diagnosing MOH begins with a detailed medical history and a thorough neurological examination, Dr. Dominguez says. “The clinician will look for specific signs in the patient’s headache history that might require additional tests, including blood tests and brain imaging. “Patients are also encouraged to keep a headache diary,” he continues. “The diary is crucial for diagnosing MOH, as it helps track how often headaches occur, the associated symptoms, the medications used and how often.” If a person meets the diagnostic criteria for MOH (mentioned earlier), they are diagnosed with MOH. How is MOH treated? The first step in treating MOH is to educate the patient on what the disorder is and why it occurs, he explains. “It's important to understand that medication overuse is not the patient’s fault. It simply means that the treatment plan needs to be optimized,” says Dr. Dominguez. Treatment includes prescribing effective [preventive medications](https://americanmigrainefoundation.org/resource-library/migraine-prevention-101/) to reduce the overall burden of headaches, meaning their frequency and severity, as well as any disability they cause. Additionally, patients are advised to discontinue or limit the use of the overused medication. In cases where that is challenging, bridge therapy, such as steroids or long-acting NSAIDs, may be considered as a way to help patients discontinue the overused medication. Regular follow-up visits with a specialist are important to ensure that the patient’s headaches are well\-controlled, he advises. Summary - Medication overuse headache (MOH) generally affects people who already have a headache disorder. - If a patient has headaches on 15 or more days a month, regularly overuses medication and has been doing so for more than 3 months, and no other cause of frequent headaches is found, they may have MOH. - Both OTC and certain prescription medications can be overused. - Specialists treat MOH by educating their patients about the condition, advising them to discontinue or limit the overused medication and prescribing effective preventive medication. - “Overuse” is not the patient’s fault. It’s normal to seek pain relief when dealing with pain. A headache specialist can help you downsize your use of the problematic medication and prescribe a preventive medication to reduce the frequency and severity of your headaches.
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